Provider Demographics
NPI:1083700736
Name:LADIMER, ERIC HOWARD (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:HOWARD
Last Name:LADIMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 SWITZER RD
Mailing Address - Street 2:APY A103
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507
Mailing Address - Country:US
Mailing Address - Phone:317-919-5376
Mailing Address - Fax:
Practice Address - Street 1:606 FISHER ST
Practice Address - Street 2:KEESLER AFB
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-377-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist