Provider Demographics
NPI:1972680148
Name:LUDWIG, JOHN BANKS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BANKS
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 1:10430 S DE ANZA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3019
Mailing Address - Country:US
Mailing Address - Phone:408-253-0523
Mailing Address - Fax:408-257-1165
Practice Address - Street 1:10430 S DE ANZA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3019
Practice Address - Country:US
Practice Address - Phone:408-253-0523
Practice Address - Fax:408-257-1165
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice