Provider Demographics
NPI:1083081293
Name:ROBERT C LUDLOW DDS INC
Entity Type:Organization
Organization Name:ROBERT C LUDLOW DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-578-4001
Mailing Address - Street 1:1317 OAKDALE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3361
Mailing Address - Country:US
Mailing Address - Phone:209-578-4001
Mailing Address - Fax:209-578-4320
Practice Address - Street 1:1317 OAKDALE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3361
Practice Address - Country:US
Practice Address - Phone:209-578-4001
Practice Address - Fax:209-578-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA228191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty