Provider Demographics
NPI:1821305780
Name:THOMAS N. LUDLOW D.D.S., INC.
Entity Type:Organization
Organization Name:THOMAS N. LUDLOW D.D.S., INC.
Other - Org Name:EXPRESSIONS IN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:LUDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-983-6767
Mailing Address - Street 1:2304 E BIDWELL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3455
Mailing Address - Country:US
Mailing Address - Phone:916-983-6767
Mailing Address - Fax:916-983-8668
Practice Address - Street 1:2304 E BIDWELL ST STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3455
Practice Address - Country:US
Practice Address - Phone:916-983-6767
Practice Address - Fax:916-983-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47638261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6530690001Medicare NSC