Provider Demographics
NPI:1184775421
Name:ROBERT W LADLEY D.M.D. PA
Entity type:Organization
Organization Name:ROBERT W LADLEY D.M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-742-3383
Mailing Address - Street 1:37918 N COUNTY ROAD 44A
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-8329
Mailing Address - Country:US
Mailing Address - Phone:352-357-5976
Mailing Address - Fax:
Practice Address - Street 1:320A W BURLEIGH BLVD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2410
Practice Address - Country:US
Practice Address - Phone:352-742-3383
Practice Address - Fax:352-742-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL92601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty