Provider Demographics
NPI:1730103391
Name:LADD DENTAL OF GREENTOWN P.C.
Entity Type:Organization
Organization Name:LADD DENTAL OF GREENTOWN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-628-2203
Mailing Address - Street 1:520 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46936-1021
Mailing Address - Country:US
Mailing Address - Phone:765-628-2203
Mailing Address - Fax:765-628-0790
Practice Address - Street 1:520 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:IN
Practice Address - Zip Code:46936-1021
Practice Address - Country:US
Practice Address - Phone:765-628-2203
Practice Address - Fax:765-628-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty