Healthcare Provider Details

I. General information

NPI: 1730285230
Provider Name (Legal Business Name): ROBERT T RUDMAN DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E CHERRY CREEK SOUTH DR 850
GLENDALE CO
80246-1518
US

IV. Provider business mailing address

4500 CHERRY CREEK DRIVE SOUTH 850
GLENDALE CO
80206-5330
US

V. Phone/Fax

Practice location:
  • Phone: 303-331-0222
  • Fax: 303-370-0124
Mailing address:
  • Phone: 303-331-0222
  • Fax: 303-370-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8025
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: