Evergreen Oral and Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DEN.00202720 Issued in CO

Legal business name

EVERGREEN ORAL AND MAXILLOFACIAL SURGERY

Practice address

28000 Meadow Dr Unit 110
Evergreen, CO 80439-8395

Phone

(720) 990-5500

Fax

(720) 990-5501

NPI assigned

May 11, 2017

Last updated

May 11, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jonathon Jundt, DDS, MDNPI 1063640316

Title

Owner / Surgeon

Phone

(720) 990-5500

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jonathon Sedrick Jundt, MD, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Evergreen, CO
  • NPI 1063640316
  NPD (past) Authorized official
• Travis W Bennett, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Eglin AFB, FL
  • NPI 1306213715
  NPD (past)

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1225564297",
    "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": "804398395",
            "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": "804398395",
            "telephone_number": "720-990-5500",
            "fax_number": "720-990-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN ORAL AND MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "JUNDT",
        "authorized_official_first_name": "JONATHON",
        "authorized_official_title_or_position": "OWNER / SURGEON",
        "authorized_official_telephone_number": "720-990-5500",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "DEN.00202720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Evergreen Operations, LLC (Life Care Center of Evergreen)
• Evergreen Pathways Counseling, LLC
• Evergreen Pediatrics, LLC (Evergreen Conifer Pediatrics)
• Evergreen Physical Therapy Specialists, PC
• Evergreen Psychotherapy Center
• Evergreen Spine and Sports Medicine LLC

• 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 May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.