Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4339 | SC |
NPI | 1053759514 |
---|---|
Provider Name | Linda Ludy |
First Address | Greenville, SC 29605-4407 |
Second Address | Greenville, SC 29605-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2013 |
Last Update Date | 12/02/2015 |