Organization
ORAL SURGERY CENTER OF KOKOMO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN LADD DDS (OWNER)
(765) 453-7710
Entity
Organization
Contact information
Practice address
3415 S LAFOUNTAIN ST, SUITE H, KOKOMO, IN 46902-3802
(765) 453-7710
Mailing address
3415 S LAFOUNTAIN ST, SUITE H, KOKOMO, IN 46902-3802
(765) 453-7710
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
12012039A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12012039A
IN
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
12012039A
IN
Other
Enumeration date
04/08/2014
Last updated
04/08/2014
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