Healthcare Provider Details

I. General information

NPI: 1801810445
Provider Name (Legal Business Name): LADD DENTAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 W LINCOLN RD
KOKOMO IN
46902-8012
US

IV. Provider business mailing address

2333 W LINCOLN RD
KOKOMO IN
46902-8012
US

V. Phone/Fax

Practice location:
  • Phone: 765-455-0085
  • Fax: 765-455-6839
Mailing address:
  • Phone: 765-455-0085
  • Fax: 765-455-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIN

VIII. Authorized Official

Name: MARY LADD
Title or Position: CEO
Credential:
Phone: 765-455-0085