Provider Demographics
NPI:1083876478
Name:LUDWIG, BRIAN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 HENRY CHAPPLE ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106
Mailing Address - Country:US
Mailing Address - Phone:406-259-7438
Mailing Address - Fax:406-259-9729
Practice Address - Street 1:625 HENRY CHAPPLE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106
Practice Address - Country:US
Practice Address - Phone:406-259-7438
Practice Address - Fax:406-259-9729
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4079DENTAL1223S0112X
MTDEN-DEN-LIC-40791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT42314Medicaid