Provider Demographics
NPI:1871078139
Name:LUDHER, DIVISPREET KAUR (DDS)
Entity type:Individual
Prefix:DR
First Name:DIVISPREET
Middle Name:KAUR
Last Name:LUDHER
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 1:2570 JAMES MADISON CIR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4321
Mailing Address - Country:US
Mailing Address - Phone:703-899-8523
Mailing Address - Fax:
Practice Address - Street 1:9000 FERN PARK DR # A2
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1602
Practice Address - Country:US
Practice Address - Phone:703-424-9481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014159281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice