Provider Demographics
NPI:1952591109
Name:LUEDER, JACOB COLBERT (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:COLBERT
Last Name:LUEDER
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 1:600 MONROE AVE NW
Mailing Address - Street 2:LOFT 205
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1473
Mailing Address - Country:US
Mailing Address - Phone:616-717-0218
Mailing Address - Fax:
Practice Address - Street 1:706 W RANDALL ST
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-1308
Practice Address - Country:US
Practice Address - Phone:616-837-7604
Practice Address - Fax:616-837-6549
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics