NPIMap

Organization Active NPI

Implant and General Dentistry of Northern Colorado

  • General Practice Dentistry
  • Loveland, CO
National Provider Identifier
1891749040
Registry record updated May 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
CO105715 Issued in CO
Legal business name
IMPLANT AND GENERAL DENTISTRY OF NORTHERN COLORADO
Practice address
2975 Ginnala Dr Ste 100
Loveland, CO 80538-3300
Phone
(970) 663-1000
Fax
(970) 663-0615
NPI assigned
May 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2012

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

Authorized official

Name
Dr. Theodore Eugene Mioduski Jr., D.D.S.NPI 1013955046
Title
Dentist
Phone
(970) 663-1000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X CO105715 CO Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X CO8285 CO

Addresses

Primary practice location

2975 Ginnala Dr Ste 100
Loveland, CO 80538-3300

Mailing address

2975 Ginnala Dr Ste 100
Loveland, CO 80538-3300
Phone (970) 663-1000

National Provider Directory

National Provider Directory

Locations

2975 Ginnala Dr
Ste 100
Loveland, CO 80538
Phone (970) 443-7117

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337212800000",
    "number": "1891749040",
    "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": {
        "organization_name": "IMPLANT AND GENERAL DENTISTRY OF NORTHERN COLORADO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2012-05-17",
        "status": "A",
        "authorized_official_last_name": "MIODUSKI",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "970-663-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "CO105715",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "CO8285",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; 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.