Healthcare Provider Details

I. General information

NPI: 1295897114
Provider Name (Legal Business Name): JAMES R LUDERITZ DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4781 E CAMP LOWELL DR STE 101
TUCSON AZ
85712-1290
US

IV. Provider business mailing address

4781 E CAMP LOWELL DR STE 101
TUCSON AZ
85712-1290
US

V. Phone/Fax

Practice location:
  • Phone: 520-298-6909
  • Fax: 520-298-7376
Mailing address:
  • Phone: 406-670-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011796
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2102
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: