John Ernest Ludwigsen, DDS
Individual provider Active NPI Dentist · Sister Bay, WI
NPI 1669540589 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1669540589
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5084015 (WI)
- Practice address
- 940 South Bayshore Drive
Sister Bay, WI 54234-9309 - Phone
- (920) 854-6556
- Fax
- (920) 854-6559
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160311000269 | WI | Order and Referring Only - Dentist |
7113223538 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5084015 | WI | MD | Dentist |
| 5084 | WI | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John E Ludwigsen DDS LTD | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5084015 | WI | Yes |
Addresses
Primary practice location
940 South Bayshore Drive
Sister Bay, WI 54234-9309
Mailing address
940 South Bayshore Drive
Sister Bay, WI 54234-9309
Phone (920) 854-6556
Other providers in Sister Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.