Provider Demographics
NPI:1487727640
Name:LUDWICK, WILLIAM BLONDELL II (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BLONDELL
Last Name:LUDWICK
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SOUTHERN DRIVE
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726
Mailing Address - Country:US
Mailing Address - Phone:304-788-9254
Mailing Address - Fax:304-788-9259
Practice Address - Street 1:55 SOUTHERN DRIVE
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726
Practice Address - Country:US
Practice Address - Phone:304-788-9254
Practice Address - Fax:304-788-9259
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4002123000Medicaid