Provider Demographics
NPI:1306801782
Name:ALDERMAN, ROBERT P (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:ALDERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14555 HAZEL DELL PKWY # B
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-7000
Mailing Address - Country:US
Mailing Address - Phone:317-569-0033
Mailing Address - Fax:317-569-0540
Practice Address - Street 1:14555 HAZEL DELL PKWY # B
Practice Address - Street 2:SUITE 140
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7000
Practice Address - Country:US
Practice Address - Phone:317-569-0033
Practice Address - Fax:317-569-0540
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7978122300000X
IN12011603A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400050763Medicare PIN