Healthcare Provider Details

I. General information

NPI: 1346382942
Provider Name (Legal Business Name): RICHARD J ACKERMANN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W HIGH ST
WARSAW KY
41095
US

IV. Provider business mailing address

PO BOX 636
WARSAW KY
41095
US

V. Phone/Fax

Practice location:
  • Phone: 859-567-5851
  • Fax: 859-567-5191
Mailing address:
  • Phone: 859-567-5851
  • Fax: 859-567-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6190
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: