=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033859384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUDINGTON FAMILY DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2022
-----------------------------------------------------
Last Update Date | 04/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 S WASHINGTON AVE
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-2283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-690-6820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 N BEECHWOOD DR
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-690-6820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ERIC DORIAN REUM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 231-690-6820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------