George Charles Hludzik, DMD
Individual provider Active NPI Dentist · Hanscom Afb, MA
NPI 1194719476 · NPPES record last updated Jan 24, 2012
Key facts
- NPI
- 1194719476
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 19680 (MA)
- Practice address
- 90 Vandenberg Dr
66 MDS (Afmc)
Hanscom Afb, MA 01731-2104 - Phone
- (781) 225-6324
- NPI assigned
- Sep 1, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19680 | MA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19680 | MA | Yes |
Addresses
Primary practice location
90 Vandenberg Dr
66 MDS (Afmc)
Hanscom Afb, MA 01731-2104
Mailing address
33 Fayette Rd
Bedford, MA 01730-2526
Phone (781) 225-6324
Other providers in Hanscom Afb, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.