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General NPI Number Information
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NPI Number | 1831610120
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Entity Type | Organization
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Legal Business Name | LADD DENTAL GROUP OF MCCORDSVILLE, INC.
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 6653 W BROADWAY
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City | MCCORDSVILLE
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State | IN
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Zip | 46055-9558
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Country | US
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Telephone | 765-455-0085
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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 |
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Authorized Official
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Title or Position | CEO
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Name | MS. MARY 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 | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | IN
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