MEDICARE: DAVID P. LADD, D.D.S., PD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12010573A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104271311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID P. LADD, D.D.S., PD

Provider Business Mailing Address
First Line	:	551 W. LINCOLN HIGHWAY
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375
Country	:	US
Telephone Number	:	219-322-3118
Fax Number	:	219-322-2763

Provider Business Practice Location Address
First Line	:	551 W US HIGHWAY 30
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2650
Country	:	US
Telephone Number	:	219-322-3118
Fax Number	:	219-322-2763

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID PAUL LADD
Credential	:	D.D.S.
Telephone Number	:	219-322-3118

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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