Provider Demographics
NPI:1710101746
Name:LUDWIG, MICHAEL SCOTTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTTT
Last Name:LUDWIG
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 1:707 HIGHWAY 33 S
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2696
Mailing Address - Country:US
Mailing Address - Phone:218-879-8357
Mailing Address - Fax:
Practice Address - Street 1:707 HIGHWAY 33 S
Practice Address - Street 2:SUITE 7
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2696
Practice Address - Country:US
Practice Address - Phone:218-879-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10672OtherSTATE LISCENSE