Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8354 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 8354 | KY |
NPI | 1346397163 |
---|---|
Provider Name | Dr. Ben Alderdice JR. |
First Address | Somerset, KY 42503-3812 |
Second Address | Somerset, KY 42503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 22/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100124480 | (05) | KY |
7100151390 | (05) | KY |