MEDICARE: DR. ERIC JOHN 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

General Provider Information

NPI Number	:	1528094315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC JOHN LADD D.D.S.

Provider Business Mailing Address
First Line	:	1636 POPLAR LN
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-3848
Country	:	US
Telephone Number	:	219-322-5090
Fax Number	:	219-322-4095

Provider Business Practice Location Address
First Line	:	555 W LINCOLN HWY
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ERIC JOHN LADD D.D.S.” Practice Location

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