Provider Demographics
NPI:1902438641
Name:DR AJLUDD DENTAL LLC
Entity Type:Organization
Organization Name:DR AJLUDD DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LUDDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-634-9111
Mailing Address - Street 1:3708 E PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5946
Mailing Address - Country:US
Mailing Address - Phone:307-634-9111
Mailing Address - Fax:
Practice Address - Street 1:3708 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5946
Practice Address - Country:US
Practice Address - Phone:307-634-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1295883452Medicaid
WY1326532441Medicaid