Healthcare Provider Details

I. General information

NPI: 1306639422
Provider Name (Legal Business Name): JUSTIN LUDWIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WASHINGTON AVE BLDG 2
NEWPORT NEWS VA
23607-2700
US

IV. Provider business mailing address

4101 WASHINGTON AVE BLDG 2
NEWPORT NEWS VA
23607-2700
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-8609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419472
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419472
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: