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General NPI Number Information
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NPI Number | 1669537924
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Entity Type | Individual
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Provider Name | KEVIN T LADESIC DDS
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 05/22/2009
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Provider Practice Location Address
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Address Line | 1403 WATERLOO AVE
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City | WEST SALEM
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State | WI
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Zip | 54669
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Country | US
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Telephone | 608-786-0909
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Fax | 608-786-4999
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Provider Business Mailing Address
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Address Line | 1403 WATERLOO AVE
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City | WEST SALEM
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State | WI
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Zip | 54669
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Country | US
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Telephone | 608-786-0909
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Fax | 608-786-4999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5788-015
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5788
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License Number State | WI
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