# EVERGREEN ORAL AND MAXILLOFACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225564297
- **Authorized official:** JONATHON JUNDT DDS, MD (OWNER / SURGEON)
- **Authorized official phone:** (720) 990-5500

## Contact information

- **Practice address:** 28000 MEADOW DR UNIT 110, EVERGREEN, CO 80439-8395
- **Practice address phone:** (720) 990-5500
- **Practice address fax:** (720) 990-5501
- **Mailing address:** 28000 MEADOW DR UNIT 110, EVERGREEN, CO 80439-8395
- **Mailing address phone:** (720) 990-5500
- **Mailing address fax:** (720) 990-5501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DEN.00202720 | CO | Yes |

## Other

- **Enumeration date:** 05/11/2017
- **Last updated:** 05/11/2017