Provider Demographics
NPI:1225197460
Name:JOHN E LUDWIGSEN DDS LTD
Entity Type:Organization
Organization Name:JOHN E LUDWIGSEN DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:LUDWIGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-854-6556
Mailing Address - Street 1:940 SOUTH BAYSHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SISTER BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54234-9309
Mailing Address - Country:US
Mailing Address - Phone:920-854-6556
Mailing Address - Fax:920-854-6559
Practice Address - Street 1:940 SOUTH BAYSHORE DRIVE
Practice Address - Street 2:
Practice Address - City:SISTER BAY
Practice Address - State:WI
Practice Address - Zip Code:54234-9309
Practice Address - Country:US
Practice Address - Phone:920-854-6556
Practice Address - Fax:920-854-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5084015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty