Individual
THEODORE E. MIODUSKI III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2975 GINNALA DR, SUITE #100, LOVELAND, CO 80538-3300
(970) 663-1000
(970) 663-0615
Mailing address
2975 GINNALA DR, SUITE #100, LOVELAND, CO 80538-3300
(970) 663-1000
(970) 663-0615
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9587
CO
Other
Enumeration date
06/07/2007
Last updated
07/16/2008
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