Provider Demographics
NPI:1578767604
Name:LUDLOW, THOMAS NELSON (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:NELSON
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 1:1001 E BIDWELL STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-983-6767
Mailing Address - Fax:916-983-8668
Practice Address - Street 1:1001 E BIDWELL STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-983-6767
Practice Address - Fax:916-983-8668
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist