Healthcare Provider Details

I. General information

NPI: 1982628194
Provider Name (Legal Business Name): DR. JOHN R. LADD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 W LINCOLN RD
KOKOMO IN
46902-8012
US

IV. Provider business mailing address

10624 W 100 S
RUSSIAVILLE IN
46979-9750
US

V. Phone/Fax

Practice location:
  • Phone: 765-455-0085
  • Fax:
Mailing address:
  • Phone: 765-883-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7486
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: