MEDICARE: DR. JILL KRISTINE MIODUSKI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10178	CO

General Provider Information

NPI Number	:	1174839740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL KRISTINE MIODUSKI D.D.S.

Provider Business Mailing Address
First Line	:	1299 MAIN ST UNIT C
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-5947
Country	:	US
Telephone Number	:	970-674-0717
Fax Number	:

Provider Business Practice Location Address
First Line	:	1299 MAIN ST UNIT C
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-5947
Country	:	US
Telephone Number	:	970-674-0717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	11/05/2021

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