Provider Demographics
NPI:1326055625
Name:LUDLOW, JEFFREY HARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HARRIS
Last Name:LUDLOW
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 1:2101 W WHITE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5347
Mailing Address - Country:US
Mailing Address - Phone:972-924-2452
Mailing Address - Fax:972-924-2459
Practice Address - Street 1:2101 W WHITE ST STE 100
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-5347
Practice Address - Country:US
Practice Address - Phone:972-924-2452
Practice Address - Fax:972-924-2459
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21693122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty