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NPI Code Detail

MEDICARE: MR. JOHN JOSEPH HEDERMAN D.D.S

MEDICARE: MR. JOHN JOSEPH HEDERMAN D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry14309TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588662712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN JOSEPH HEDERMAN D.D.S
Provider Business Mailing Address
First Line : 2548 MEMORIAL BLVD
Second Line :
City : PORT ARTHUR
State : TX
Zip : 77640-2825
Country : US
Telephone Number : 409-983-1161
Fax Number : 409-983-4933
Provider Business Practice Location Address
First Line : 2548 MEMORIAL BLVD
Second Line :
City : PORT ARTHUR
State : TX
Zip : 77640-2825
Country : US
Telephone Number : 409-983-1161
Fax Number : 409-983-4933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 08/03/2011

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