Provider Demographics
NPI:1063640316
Name:JUNDT, JONATHON SEDRICK (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:SEDRICK
Last Name:JUNDT
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 MEADOW DR UNIT 110
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8467
Mailing Address - Country:US
Mailing Address - Phone:720-990-5500
Mailing Address - Fax:720-990-5501
Practice Address - Street 1:28000 MEADOW DR UNIT 110
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-8467
Practice Address - Country:US
Practice Address - Phone:720-990-5500
Practice Address - Fax:720-990-5501
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0024657122300000X, 1223S0112X
CODEN.00202720122300000X
CODR.00584661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000162920Medicaid