Provider Demographics
NPI:1912296245
Name:DRS. DEMUTH-SIMON-HAERIAN & LUDWIG PLC
Entity type:Organization
Organization Name:DRS. DEMUTH-SIMON-HAERIAN & LUDWIG PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:419-882-1017
Mailing Address - Street 1:7928 SECOR RD
Mailing Address - Street 2:PO BOX 860
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9619
Mailing Address - Country:US
Mailing Address - Phone:734-854-6221
Mailing Address - Fax:734-854-6224
Practice Address - Street 1:7928 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9619
Practice Address - Country:US
Practice Address - Phone:734-854-6221
Practice Address - Fax:734-854-6224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYLVANIA ORTHODONTICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI185541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty