Provider Demographics
NPI:1891182846
Name:JEREMY G CARDON DMD
Entity Type:Organization
Organization Name:JEREMY G CARDON DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-814-9899
Mailing Address - Street 1:718 MALETA LN
Mailing Address - Street 2:STE 102
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7602
Mailing Address - Country:US
Mailing Address - Phone:303-814-9899
Mailing Address - Fax:303-814-3887
Practice Address - Street 1:718 MALETA LN
Practice Address - Street 2:STE 102
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7602
Practice Address - Country:US
Practice Address - Phone:303-814-9899
Practice Address - Fax:303-814-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Single Specialty