Provider Demographics
NPI:1831485929
Name:LUDFORD DENTAL, P.C.
Entity Type:Organization
Organization Name:LUDFORD DENTAL, P.C.
Other - Org Name:RT. 14 DENTISTRY & DENTAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-455-3368
Mailing Address - Street 1:6315 NORTHWEST HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7939
Mailing Address - Country:US
Mailing Address - Phone:815-455-3368
Mailing Address - Fax:815-455-3306
Practice Address - Street 1:6315 NORTHWEST HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7939
Practice Address - Country:US
Practice Address - Phone:815-455-3368
Practice Address - Fax:815-455-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0167001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty