MEDICARE: WILLIAM R LUDDEN DMD PC

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659978054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM R LUDDEN DMD PC

Provider Business Mailing Address
First Line	:	7799 CHURCH ST
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-2431
Country	:	US
Telephone Number	:	901-872-8151
Fax Number	:

Provider Business Practice Location Address
First Line	:	7799 CHURCH ST
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-2431
Country	:	US
Telephone Number	:	901-872-8151
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM R LUDDEN
Credential	:	DMD
Telephone Number	:	901-872-8151

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/08/2020

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