Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 4939 | KY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 4939 | KY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 4939 | KY |
NPI | 1518973478 |
---|---|
Provider Name | Bennie B. Alderdice SR. |
First Address | Somerset, KY 42503-3812 |
Second Address | Somerset, KY 42503-3812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 27/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000048337 | ANTHEM BC/BS (01) | KY |
0041586 | BC/BS OF TN. (01) | TN |
4300039 | UNITED HEALTHCARE MEDICAL (01) | KY |
5004539 | PASSPORT (01) | KY |
60049392 | (05) | KY |
63437-1 | UNITED HEALTHCARE DENTAL (01) | KY |
64049398 | (05) | KY |
T54107 | (02) | KY |