MEDICARE: DR. AUSTIN JOSEPH LADNER D.M.D.

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	3696-13	MS

General Provider Information

NPI Number	:	1912345448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN JOSEPH LADNER D.M.D.

Provider Business Mailing Address
First Line	:	528 MEADOW LN
Second Line	:
City	:	WAVELAND
State	:	MS
Zip	:	39576-3236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	99TH AIR BASE WING PUBLIC AFFAIRS
Second Line	:
City	:	FPO
State	:	AA
Zip	:	89191
Country	:	US
Telephone Number	:	702-652-2750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	06/06/2013

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