Provider Demographics
NPI:1275667420
Name:20 MILE ORTHDONTICS, LLP
Entity Type:Organization
Organization Name:20 MILE ORTHDONTICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDUNIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-841-2262
Mailing Address - Street 1:11355 S PARKER RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7403
Mailing Address - Country:US
Mailing Address - Phone:303-841-2262
Mailing Address - Fax:303-840-9672
Practice Address - Street 1:11355 S PARKER RD
Practice Address - Street 2:SUITE 109
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7403
Practice Address - Country:US
Practice Address - Phone:303-841-2262
Practice Address - Fax:303-840-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA89101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty