Theodore Eugene Mioduski Jr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

CO105715 Issued in CO

Practice address

2975 Ginnala Dr Ste 100
Loveland, CO 80538-3300

Phone

(970) 663-1000

Fax

(970) 663-0615

NPI assigned

Jun 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 22, 2016 through Mar 22, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Implant and General Dentistry of Northern Colorado

  • General Practice Dentistry
  • Loveland, CO
  • NPI 1891749040
  NPD (past) Authorized official
• Colorado Dental Professionals, LLC

  • General Practice Dentistry
  • Loveland, CO
  • NPI 1013697150
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199404800000",
    "number": "1013955046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 GINNALA DR STE 100",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805383300",
            "telephone_number": "970-663-1000",
            "fax_number": "970-663-0615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 GINNALA DR STE 100",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805383300",
            "telephone_number": "970-663-1000",
            "fax_number": "970-663-0615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIODUSKI",
        "first_name": "THEODORE",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2008-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "CO105715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaila Rose Milon, COTA/L
• Mind Matters Counseling Services, Inc.
• Jocelyn A Minette, RN
• Minty LLC
• Theodore E. Mioduski III, D.D.S.
• Christopher Drumm Mitchell, MD
• Connie A Mitchell, MA, NCC, LPC
• Roxanne Mitchell, OTR/L
• Nicholaus Mize, D.O
• MMC Specialty Clinic

• General Practice Dentistry in Loveland, CO
• Providers in Loveland, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.