Provider Demographics
NPI:1114173135
Name:JONATHAN S. LUDWIG, DMD, PA
Entity Type:Organization
Organization Name:JONATHAN S. LUDWIG, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-710-6849
Mailing Address - Street 1:1014 GRANDIFLORA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7454
Mailing Address - Country:US
Mailing Address - Phone:910-371-5965
Mailing Address - Fax:910-371-5959
Practice Address - Street 1:1014 GRANDIFLORA DR
Practice Address - Street 2:SUITE B
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7454
Practice Address - Country:US
Practice Address - Phone:910-371-5965
Practice Address - Fax:910-371-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-10
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC85051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty