Organization Name: | GARY P LUDKA D D S P A |
NPI Number: | 1083011910 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GARY P LUDKA (DENTIST) |
Mailing Address: | 4373 Northview Dr Bowie |
State: | MD US |
Postal Code: | 207162603 |
Phone Number: | 3014648707 |
Fax Number: | 3014644609 |
NPI Enumeration Date: | 11/20/2014 |
NPI Last Update Date: | 11/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |