Provider Demographics
NPI:1316932320
Name:TEDMAN, ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:TEDMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534-1806
Mailing Address - Country:US
Mailing Address - Phone:785-284-2323
Mailing Address - Fax:785-284-0075
Practice Address - Street 1:112 N 9TH ST
Practice Address - Street 2:
Practice Address - City:SABETHA
Practice Address - State:KS
Practice Address - Zip Code:66534-1806
Practice Address - Country:US
Practice Address - Phone:785-284-2323
Practice Address - Fax:785-284-0075
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS66281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1005342Medicaid
KS019255OtherBLUE CROSS BLUE SHIELD ID
KS100226070-AMedicaid