Provider Demographics
NPI:1043610421
Name:RUDERSDORF, GRACE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ELIZABETH
Last Name:RUDERSDORF
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 1:10000 COMMONS ST
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5501
Mailing Address - Country:US
Mailing Address - Phone:303-790-8080
Mailing Address - Fax:303-790-0679
Practice Address - Street 1:10000 COMMONS ST
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5501
Practice Address - Country:US
Practice Address - Phone:303-790-8080
Practice Address - Fax:303-790-0679
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist