=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912140989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUNTER FAMILY DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2009
-----------------------------------------------------
Last Update Date | 04/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 N 8TH ST STE 7
-----------------------------------------------------
City | GUNTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75058-3585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-924-2452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 W WHITE ST STE 2
-----------------------------------------------------
City | ANNA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75409-4102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-924-2452
-----------------------------------------------------
Fax | 972-924-2459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JEFFREY H LUDLOW
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 972-924-2452
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 21693
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------