Organization
PERIO PLASTIC & IMPLANTOLOGY CENTER OF KOKOMO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN LADD DDS (OWNER)
(765) 455-0085
Entity
Organization
Contact information
Practice address
3415 S LAFOUNTAIN ST, SUITE H, KOKOMO, IN 46902-3802
(765) 455-0085
Mailing address
2333 W LINCOLN RD, KOKOMO, IN 46902-8012
(765) 455-0085
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
12011521A
IN
1223P0300X
Periodontics
Primary
12011521A
IN
Other
Enumeration date
07/07/2015
Last updated
07/07/2015
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