Provider Demographics
NPI:1104271311
Name:DAVID P. LADD, D.D.S., PD
Entity type:Organization
Organization Name:DAVID P. LADD, D.D.S., PD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-322-3118
Mailing Address - Street 1:551 W. LINCOLN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375
Mailing Address - Country:US
Mailing Address - Phone:219-322-3118
Mailing Address - Fax:219-322-2763
Practice Address - Street 1:551 W US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2650
Practice Address - Country:US
Practice Address - Phone:219-322-3118
Practice Address - Fax:219-322-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010573A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200451280Medicaid