Healthcare Provider Details

I. General information

NPI: 1912971540
Provider Name (Legal Business Name): DAVID PAUL LADD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 W LINCOLN HWY
SCHERERVILLE IN
46375-2650
US

IV. Provider business mailing address

10340 WHITE OAK LN UNIT 1D
MUNSTER IN
46321-6800
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-3118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010573A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: