Provider Demographics
NPI:1972217560
Name:MCGRUDER, REBECCA (RDH MPH)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:MCGRUDER
Suffix:
Gender:F
Credentials:RDH MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5376 LEWISTON CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-7044
Mailing Address - Country:US
Mailing Address - Phone:303-523-0622
Mailing Address - Fax:
Practice Address - Street 1:1062 AKRON WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7102
Practice Address - Country:US
Practice Address - Phone:303-365-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000904892124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist