Provider Demographics
NPI:1174839740
Name:MIODUSKI, JILL KRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:KRISTINE
Last Name:MIODUSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 MAIN ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5947
Mailing Address - Country:US
Mailing Address - Phone:970-674-0717
Mailing Address - Fax:
Practice Address - Street 1:1299 MAIN ST UNIT C
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5947
Practice Address - Country:US
Practice Address - Phone:970-674-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics