MEDICARE: JOHN W. ADELSPERGER 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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12009942A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1588667448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN W. ADELSPERGER D.D.S.

Provider Business Mailing Address
First Line	:	10972 ALLISONVILLE RD
Second Line	:	SUITE 110
City	:	FISHERS
State	:	IN
Zip	:	46038-2637
Country	:	US
Telephone Number	:	317-845-7878
Fax Number	:	317-570-7193

Provider Business Practice Location Address
First Line	:	777 BEACHWAY DR
Second Line	:	SUITE 202
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-7700
Country	:	US
Telephone Number	:	317-297-1007
Fax Number	:	317-297-7069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/26/2014

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