MEDICARE: ERIC LADD, D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	12009030A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245788066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC LADD, D.D.S.

Provider Business Mailing Address
First Line	:	555 W US HIGHWAY 30
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2650
Country	:	US
Telephone Number	:	219-322-5090
Fax Number	:	219-322-4095

Provider Business Practice Location Address
First Line	:	555 W US HIGHWAY 30
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2650
Country	:	US
Telephone Number	:	219-322-5090
Fax Number	:	219-322-4095

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	AIMEE JOHNSON
Credential	:
Telephone Number	:	219-322-5090

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/21/2016

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Directions to “ERIC LADD, D.D.S. ” Practice Location

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