Provider Demographics
NPI:1023130812
Name:LOUDERMILK, ROBERT L (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:LOUDERMILK
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 1:226 WEST HISTORIC EIGHTH STREET
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016
Mailing Address - Country:US
Mailing Address - Phone:765-642-2900
Mailing Address - Fax:765-642-3580
Practice Address - Street 1:226 WEST HISTORIC EIGHTH STREET
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016
Practice Address - Country:US
Practice Address - Phone:765-642-2900
Practice Address - Fax:765-642-3580
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008921A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100172320AMedicaid