Provider Demographics
NPI:1821164815
Name:LUDWIG, STEPHEN ELLIOTT
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ELLIOTT
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 WASHINGTON BLVD SUITE D
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521
Mailing Address - Country:US
Mailing Address - Phone:925-672-6200
Mailing Address - Fax:925-672-2645
Practice Address - Street 1:1494 WASHINGTON BLVD SUITE D
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521
Practice Address - Country:US
Practice Address - Phone:925-672-6200
Practice Address - Fax:925-672-2645
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics