Provider Demographics
NPI:1962448191
Name:MUDD, CARA L (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:L
Last Name:MUDD
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:L
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:14697 DELAWARE STREET
Mailing Address - Street 2:BLDG. B, SUITE #210
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023
Mailing Address - Country:US
Mailing Address - Phone:303-650-0310
Mailing Address - Fax:303-650-0311
Practice Address - Street 1:14697 DELAWARE STREET
Practice Address - Street 2:BLDG. B, SUITE #210
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023
Practice Address - Country:US
Practice Address - Phone:303-650-0310
Practice Address - Fax:303-650-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5812MUOtherREGENCE BLUESHIELD INS
WA5046693Medicaid
WA5046693Medicaid