Provider Demographics
NPI:1386821338
Name:R. BURTON LUDRICK, D.D.S., PC
Entity Type:Organization
Organization Name:R. BURTON LUDRICK, D.D.S., PC
Other - Org Name:ROBERT BURTON LUDRICK D.D.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER/SPOUSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:WRYNNE
Authorized Official - Last Name:LUDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-924-6960
Mailing Address - Street 1:720 BRYAN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7032
Mailing Address - Country:US
Mailing Address - Phone:580-924-6960
Mailing Address - Fax:580-924-6665
Practice Address - Street 1:720 BRYAN DR
Practice Address - Street 2:SUITE B
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7032
Practice Address - Country:US
Practice Address - Phone:580-924-6960
Practice Address - Fax:580-924-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty