MEDICARE: RODGER L. MAECHTLEN DDS

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	1223G0001X	General Practice Dentistry	4613	KS

General Provider Information

NPI Number	:	1588634190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODGER L. MAECHTLEN DDS

Provider Business Mailing Address
First Line	:	2017 E CHESTNUT AVE
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-8538
Country	:	US
Telephone Number	:	620-442-3719
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 EDGEMONT DR
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-3844
Country	:	US
Telephone Number	:	620-442-2040
Fax Number	:

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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