Provider Demographics
NPI:1902942147
Name:LUDLOW, JEREMY L (DMD)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:L
Last Name:LUDLOW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 1325 N
Mailing Address - Street 2:#125
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720
Mailing Address - Country:US
Mailing Address - Phone:435-586-3884
Mailing Address - Fax:435-586-9671
Practice Address - Street 1:110 W 1325 N
Practice Address - Street 2:#125
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720
Practice Address - Country:US
Practice Address - Phone:435-586-3884
Practice Address - Fax:435-586-9671
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT625940999211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
205698516Medicare UPIN