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General NPI Number Information
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NPI Number | 1386821338
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Entity Type | Organization
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Legal Business Name | R. BURTON LUDRICK, D.D.S., PC
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 720 BRYAN DR SUITE B
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City | DURANT
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State | OK
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Zip | 74701-7032
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Country | US
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Telephone | 580-924-6960
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Fax | 580-924-6665
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Provider Business Mailing Address
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Address Line | 720 BRYAN DR SUITE B
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City | DURANT
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State | OK
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Zip | 74701-7032
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Country | US
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Telephone | 580-924-6960
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Fax | 580-924-6665
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Authorized Official
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Title or Position | OFFICE MANAGER/SPOUSE
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Name | MRS. HARRIET WRYNNE LUDRICK
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Credential |
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Telephone | 580-924-6960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3727
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License Number State | OK
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