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General NPI Number Information
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NPI Number | 1669912234
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Entity Type | Organization
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Legal Business Name | LADD ORTHODONTICS OF LOGANSPORT, LLC
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 335 MALL RD
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City | LOGANSPORT
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State | IN
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Zip | 46947-2279
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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
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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 | MS. MARY ELIZABETH LADD
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Credential |
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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 | 12010466A
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License Number State | IN
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