| NPI | 1992124879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LADD Owner 765-453-7710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IN 12012039A) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: IN 12012039A) |
| 261QS0112X Clinic/Center Oral and Maxillofacial Surgery (Licence: IN 12012039A) | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2014-04-08 |