Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 3727 | OK |
NPI | 1003985847 |
---|---|
Provider Name | Dr. Robert B Ludrick |
First Address | Durant, OK 74701 |
Second Address | Durant, OK 74701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 09/07/2007 |