Provider Demographics
NPI:1164023826
Name:MAGRUDER, KAY (RDH, OMT)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:MAGRUDER
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 LONE TREE LN
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-7871
Mailing Address - Country:US
Mailing Address - Phone:970-275-3891
Mailing Address - Fax:
Practice Address - Street 1:646 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3913
Practice Address - Country:US
Practice Address - Phone:970-275-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000002954124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO921415152OtherDRIVERS LICENSE