Provider Demographics
NPI:1982097119
Name:LUDWIG, DAVID C (D D S, M D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:D D S, M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 S UNION AVE STE B16
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1333
Mailing Address - Country:US
Mailing Address - Phone:253-759-3718
Mailing Address - Fax:
Practice Address - Street 1:2302 S UNION AVE STE B16
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1333
Practice Address - Country:US
Practice Address - Phone:253-759-3718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60926946204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery