MEDICARE: DR. JOHN B LUDU DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00007361	WA

General Provider Information

NPI Number	:	1023000163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN B LUDU DMD

Provider Business Mailing Address
First Line	:	PO BOX 1361
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-0056
Country	:	US
Telephone Number	:	425-413-8505
Fax Number	:	425-413-8144

Provider Business Practice Location Address
First Line	:	23866 SE KENT KANGLEY RD
Second Line	:
City	:	MAPLE VALLEY
State	:	WA
Zip	:	98038-6848
Country	:	US
Telephone Number	:	425-413-8505
Fax Number	:	425-413-8144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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