Healthcare Provider Details

I. General information

NPI: 1215915798
Provider Name (Legal Business Name): RICHARD L LUDWIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 HASLETT RD STE #2
HASLETT MI
48840-8469
US

IV. Provider business mailing address

1660 HASLETT RD STE #2
HASLETT MI
48840-8469
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-1012
  • Fax: 517-339-0642
Mailing address:
  • Phone: 517-339-1012
  • Fax: 517-339-0642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13173
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: