Jonathon Sedrick Jundt, MD, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DR.0058466 Issued in CO

Practice address

28000 Meadow Dr Unit 110
Evergreen, CO 80439-8467

Phone

(720) 990-5500

Fax

(720) 990-5501

NPI assigned

Jun 25, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2025 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Evergreen Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Evergreen, CO
  • NPI 1225564297
  NPD (past) Authorized official
• Dale M. Gallagher, D.D.S., P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Austin, TX
  • NPI 1992900559
  NPD (past)

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1063640316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28000 MEADOW DR UNIT 110",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804398467",
            "telephone_number": "720-990-5500",
            "fax_number": "720-990-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28000 MEADOW DR UNIT 110",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804398467",
            "telephone_number": "720-990-5500",
            "fax_number": "720-990-5501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6516 M D Anderson Blvd",
            "address_2": "Suite 2.059",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770303402",
            "country_code": "US",
            "telephone_number": "713-500-4200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11700 W 2nd Pl Ste 210",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CO",
            "postal_code": "802281716",
            "country_code": "US",
            "telephone_number": "720-321-8080",
            "fax_number": "720-321-8081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUNDT",
        "first_name": "JONATHON",
        "middle_name": "SEDRICK",
        "name_prefix": "Dr.",
        "credential": "MD, DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "0024657",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00202720",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "0024657",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "DR.0058466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000162920",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan K. Brooks PHD PC
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• Nicole Kalinowski, MA, LPCC
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• Arnon Katz, PSY.D.
• Elizabeth Passavent Kaufmann, PT

• Oral and Maxillofacial Surgery (Dentist) in Evergreen, CO
• Providers in Evergreen, CO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.