Provider Demographics
NPI:1043429913
Name:LUDLOW FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LUDLOW FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MITERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMDFAGD
Authorized Official - Phone:413-583-6574
Mailing Address - Street 1:257 KENDALL ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1055
Mailing Address - Country:US
Mailing Address - Phone:413-583-6574
Mailing Address - Fax:
Practice Address - Street 1:257 KENDALL ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1055
Practice Address - Country:US
Practice Address - Phone:413-583-6574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty