Provider Demographics
NPI:1679093926
Name:RUDIN, JOSHUA MARTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MARTIN
Last Name:RUDIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4370
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-4370
Mailing Address - Country:US
Mailing Address - Phone:970-328-6848
Mailing Address - Fax:
Practice Address - Street 1:35 LINDBERGH DR. SUITE 107
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637-4370
Practice Address - Country:US
Practice Address - Phone:970-328-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002032141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice