Provider Demographics
NPI:1417260787
Name:RIDGEVIEW PEDIATRIC DENTISTRY PC
Entity Type:Organization
Organization Name:RIDGEVIEW PEDIATRIC DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MUDD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:303-650-0310
Mailing Address - Street 1:14697 DELAWARE ST
Mailing Address - Street 2:BLDG. B, SUITE #210
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9178
Mailing Address - Country:US
Mailing Address - Phone:303-650-0310
Mailing Address - Fax:303-650-0311
Practice Address - Street 1:14697 DELAWARE ST
Practice Address - Street 2:BLDG. B, SUITE #210
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9178
Practice Address - Country:US
Practice Address - Phone:303-650-0310
Practice Address - Fax:303-650-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8289261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental