Provider Demographics
NPI:1013429778
Name:GRACE E. RUDERSDORF, DDS, PLLC
Entity Type:Organization
Organization Name:GRACE E. RUDERSDORF, DDS, PLLC
Other - Org Name:GOLDEN HILL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDERSDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-237-1553
Mailing Address - Street 1:11290 W ALAMEDA AVE STE A-100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2575
Mailing Address - Country:US
Mailing Address - Phone:303-237-1553
Mailing Address - Fax:303-232-1683
Practice Address - Street 1:11290 W ALAMEDA AVE STE A-100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2575
Practice Address - Country:US
Practice Address - Phone:303-237-1553
Practice Address - Fax:303-232-1683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO202316261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental