Provider Demographics
NPI:1851384580
Name:LADINE, JEFFREY KERPER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KERPER
Last Name:LADINE
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 1:2417 MCGUIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:JB MDL
Mailing Address - State:NJ
Mailing Address - Zip Code:08641-5116
Mailing Address - Country:US
Mailing Address - Phone:609-754-3787
Mailing Address - Fax:
Practice Address - Street 1:2417 MCGUIRE BLVD
Practice Address - Street 2:
Practice Address - City:JOINT BASE MDL
Practice Address - State:NJ
Practice Address - Zip Code:08641
Practice Address - Country:US
Practice Address - Phone:609-754-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1027451329OtherDOD ID