MEDICARE: LADD DENTAL OF GREENTOWN P.C.

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	1223G0001X	General Practice Dentistry		IN

General Provider Information

NPI Number	:	1730103391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADD DENTAL OF GREENTOWN P.C.

Provider Business Mailing Address
First Line	:	520 W MAIN ST
Second Line	:
City	:	GREENTOWN
State	:	IN
Zip	:	46936-1021
Country	:	US
Telephone Number	:	765-628-2203
Fax Number	:	765-628-0790

Provider Business Practice Location Address
First Line	:	520 W MAIN ST
Second Line	:
City	:	GREENTOWN
State	:	IN
Zip	:	46936-1021
Country	:	US
Telephone Number	:	765-628-2203
Fax Number	:	765-628-0790

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN R LADD
Credential	:
Telephone Number	:	765-628-2203

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	08/22/2020

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