Organization
IMPLANT AND GENERAL DENTISTRY OF NORTHERN COLORADO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE EUGENE MIODUSKI JR. D.D.S. (DENTIST)
(970) 663-1000
Entity
Organization
Contact information
Practice address
2975 GINNALA DR STE 100, LOVELAND, CO 80538-3300
(970) 663-1000
(970) 663-0615
Mailing address
2975 GINNALA DR STE 100, LOVELAND, CO 80538-3300
(970) 663-1000
(970) 663-0615
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
CO105715
CO
1223G0001X
General Practice Dentistry
CO8285
CO
Other
Enumeration date
05/20/2006
Last updated
05/17/2012
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