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General NPI Number Information
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NPI Number | 1467735332
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Entity Type | Organization
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Legal Business Name | LADD ORTHODONTICS, P.C.
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 3415 S LAFOUNTAIN ST SUITE A
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City | KOKOMO
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State | IN
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Zip | 46902-3802
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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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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 | CEO
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Name | DR. JOHN LADD
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Credential | DDS
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12010856A
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License Number State | IN
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