Healthcare Provider Details

I. General information

NPI: 1215280896
Provider Name (Legal Business Name): ALDERMAN ORAL & MAXILLOFACIAL SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 HAZEL DELL PKWY # B SUITE 140
CARMEL IN
46033-7000
US

IV. Provider business mailing address

14555 HAZEL DELL PKWY # B SUITE 140
CARMEL IN
46033-7000
US

V. Phone/Fax

Practice location:
  • Phone: 317-569-0033
  • Fax: 317-569-0540
Mailing address:
  • Phone: 317-560-0033
  • Fax: 317-569-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number120116031
License Number StateIN

VIII. Authorized Official

Name: DR. ROBERT ALDERMAN
Title or Position: PRESIDENT
Credential:
Phone: 317-569-0033