Provider Demographics
NPI:1295897114
Name:LUDERITZ, JAMES R (DDS MS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:LUDERITZ
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 CAPRICORN PL
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-5707
Mailing Address - Country:US
Mailing Address - Phone:406-670-5303
Mailing Address - Fax:
Practice Address - Street 1:1690 RIMROCK RD STE C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0700
Practice Address - Country:US
Practice Address - Phone:406-248-7172
Practice Address - Fax:406-248-7174
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000021024OtherBLUE CROSS BLUE SHIELD MT