Healthcare Provider Details

I. General information

NPI: 1508048208
Provider Name (Legal Business Name): TOMASZ LUDWICZAK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 UPPER HEMBREE RD STE C
ROSWELL GA
30076-0913
US

IV. Provider business mailing address

1115 UPPER HEMBREE RD STE C
ROSWELL GA
30076-0913
US

V. Phone/Fax

Practice location:
  • Phone: 678-674-6466
  • Fax:
Mailing address:
  • Phone: 678-674-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013553
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: