Provider Demographics
NPI:1386856227
Name:ACCESS DENTAL CARE CLINIC PC
Entity Type:Organization
Organization Name:ACCESS DENTAL CARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LUDDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-632-6665
Mailing Address - Street 1:405 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WI
Mailing Address - Zip Code:82001
Mailing Address - Country:US
Mailing Address - Phone:307-632-6665
Mailing Address - Fax:307-637-6733
Practice Address - Street 1:405 E 19TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WI
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-632-6665
Practice Address - Fax:307-637-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY939261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental