Provider Demographics
NPI:1508862277
Name:LUEDDE, JAY CLARKSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:CLARKSON
Last Name:LUEDDE
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 1:827 DEEP VALLEY DR
Mailing Address - Street 2:STE 206
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3654
Mailing Address - Country:US
Mailing Address - Phone:310-377-6944
Mailing Address - Fax:310-541-4477
Practice Address - Street 1:827 DEEP VALLEY DR
Practice Address - Street 2:STE 206
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3654
Practice Address - Country:US
Practice Address - Phone:310-377-6944
Practice Address - Fax:310-541-4477
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist