Provider Demographics
NPI:1083011910
Name:GARY P LUDKA D D S P A
Entity Type:Organization
Organization Name:GARY P LUDKA D D S P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUDKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-464-8707
Mailing Address - Street 1:4373 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2603
Mailing Address - Country:US
Mailing Address - Phone:301-464-8707
Mailing Address - Fax:301-464-4609
Practice Address - Street 1:4373 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2603
Practice Address - Country:US
Practice Address - Phone:301-464-8707
Practice Address - Fax:301-464-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9196122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty