=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831820653
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNA MALONE LUDIN DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2022
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6700 CROSSWINDS DR N STE 100C
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33710-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-345-1774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6700 CROSSWINDS DR N STE 100C
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33710-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-909-6491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN27477
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------