Provider Demographics
NPI:1598918468
Name:LUDLOW DENTAL P.C.
Entity Type:Organization
Organization Name:LUDLOW DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REVATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAXMINARAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-423-2493
Mailing Address - Street 1:45 LUDLOW ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1947
Mailing Address - Country:US
Mailing Address - Phone:914-423-2493
Mailing Address - Fax:914-423-0263
Practice Address - Street 1:45 LUDLOW ST
Practice Address - Street 2:SUITE 606
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1947
Practice Address - Country:US
Practice Address - Phone:914-423-2493
Practice Address - Fax:914-423-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0448231223G0001X
NY0333161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01452675Medicaid