Provider Demographics
NPI:1588667448
Name:ADELSPERGER, JOHN W (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:ADELSPERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10972 ALLISONVILLE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2637
Mailing Address - Country:US
Mailing Address - Phone:317-845-7878
Mailing Address - Fax:317-570-7193
Practice Address - Street 1:777 BEACHWAY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-7700
Practice Address - Country:US
Practice Address - Phone:317-297-1007
Practice Address - Fax:317-297-7069
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009942A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200337060Medicaid
INU85467Medicare UPIN
IN268030NMedicare ID - Type Unspecified