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General NPI Number Information
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NPI Number | 1093017907
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Entity Type | Organization
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Legal Business Name | LADD DENTAL GROUP OF PERU, P.C.
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 980 N BROADWAY
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City | PERU
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State | IN
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Zip | 46970-1070
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Country | US
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Telephone | 765-473-0141
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Fax |
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Provider Business Mailing Address
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Address Line | 2333 W LINCOLN RD
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City | KOKOMO
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State | IN
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Zip | 46902-8012
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Country | US
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Telephone | 765-455-0085
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Fax | 765-455-6839
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Authorized Official
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Title or Position | OWNER/CEO
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Name | JOHN RALPH LADD
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Credential | D.D.S.
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Telephone | 765-455-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7486
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License Number State | IN
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