Provider Demographics
NPI:1508048208
Name:LUDWICZAK, TOMASZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMASZ
Middle Name:
Last Name:LUDWICZAK
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 1:5471 BELLS FERRY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7519
Mailing Address - Country:US
Mailing Address - Phone:770-928-7243
Mailing Address - Fax:770-591-8800
Practice Address - Street 1:5471 BELLS FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7519
Practice Address - Country:US
Practice Address - Phone:770-928-7243
Practice Address - Fax:770-591-8800
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist