# ORAL SURGERY CENTER OF KOKOMO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992124879
- **Authorized official:** DR. JOHN LADD DDS (OWNER)
- **Authorized official phone:** (765) 453-7710

## Contact information

- **Practice address:** 3415 S LAFOUNTAIN ST, SUITE H, KOKOMO, IN 46902-3802
- **Practice address phone:** (765) 453-7710
- **Mailing address:** 3415 S LAFOUNTAIN ST, SUITE H, KOKOMO, IN 46902-3802
- **Mailing address phone:** (765) 453-7710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | 12012039A | IN | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12012039A | IN | Yes |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | 12012039A | IN | — |

## Other

- **Enumeration date:** 04/08/2014
- **Last updated:** 04/08/2014