| NPI | 1982087078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LADD Owner 765-455-0085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IN 12011521A) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: IN 12011521A) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |