=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417260787
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIDGEVIEW PEDIATRIC DENTISTRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2010
-----------------------------------------------------
Last Update Date | 07/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14697 DELAWARE ST BLDG. B, SUITE #210
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80023-9178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-650-0310
-----------------------------------------------------
Fax | 303-650-0311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14697 DELAWARE ST BLDG. B, SUITE #210
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80023-9178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-650-0310
-----------------------------------------------------
Fax | 303-650-0311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | CARA LYNN MUDD
-----------------------------------------------------
Credential | DDS, MSD
-----------------------------------------------------
Telephone | 303-650-0310
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 8289
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------