MEDICARE: JOHN D. ALDERMAN DDS PA

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	122300000X	Dentist	6319	KS

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	:	1972849867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D. ALDERMAN DDS PA

Provider Business Mailing Address
First Line	:	111 W MAIN ST
Second Line	:
City	:	COUNCIL GROVE
State	:	KS
Zip	:	66846-1702
Country	:	US
Telephone Number	:	620-767-6744
Fax Number	:	620-767-6744

Provider Business Practice Location Address
First Line	:	111 W MAIN ST
Second Line	:
City	:	COUNCIL GROVE
State	:	KS
Zip	:	66846-1702
Country	:	US
Telephone Number	:	620-767-6744
Fax Number	:	620-767-6744

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN DONALD ALDERMAN
Credential	:	DDS
Telephone Number	:	620-767-6744

Provider Enumeration Date	:	12/20/2012
Last Update Date	:	12/20/2012

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