Healthcare Provider Details

I. General information

NPI: 1316932320
Provider Name (Legal Business Name): ELIZABETH TEDMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N 9TH ST
SABETHA KS
66534-1806
US

IV. Provider business mailing address

112 N 9TH ST
SABETHA KS
66534-1806
US

V. Phone/Fax

Practice location:
  • Phone: 785-284-2323
  • Fax: 785-284-0075
Mailing address:
  • Phone: 785-284-2323
  • Fax: 785-284-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6628
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: