Provider Demographics
NPI:1124591011
Name:LUDINGTON DENTAL, PLLC
Entity Type:Organization
Organization Name:LUDINGTON DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARISSIMA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:ALOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-843-2751
Mailing Address - Street 1:102 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2283
Mailing Address - Country:US
Mailing Address - Phone:231-843-2751
Mailing Address - Fax:231-845-8336
Practice Address - Street 1:102 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2283
Practice Address - Country:US
Practice Address - Phone:231-843-2751
Practice Address - Fax:231-845-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental