Provider Demographics
NPI:1548505803
Name:LUDDEN, MARISA CRISTINA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:CRISTINA
Last Name:LUDDEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 BONITA RD
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1701
Mailing Address - Country:US
Mailing Address - Phone:619-267-2115
Mailing Address - Fax:
Practice Address - Street 1:5050 BONITA RD
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902
Practice Address - Country:US
Practice Address - Phone:619-267-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist