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General NPI Number Information
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NPI Number | 1275667420
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Entity Type | Organization
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Legal Business Name | 20 MILE ORTHDONTICS, LLP
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11355 S PARKER RD SUITE 109
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City | PARKER
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State | CO
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Zip | 80134-7403
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Country | US
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Telephone | 303-841-2262
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Fax | 303-840-9672
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Provider Business Mailing Address
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Address Line | 11355 S PARKER RD SUITE 109
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City | PARKER
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State | CO
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Zip | 80134-7403
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Country | US
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Telephone | 303-841-2262
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Fax | 303-840-9672
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JILL GARDUNIO
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Credential |
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Telephone | 303-841-2262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8910
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License Number State | VA
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