Healthcare Provider Details

I. General information

NPI: 1013930767
Provider Name (Legal Business Name): THEODORE R LERNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THEODORE R LERNER DDS

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 GLADES RD SUITE 204
BOCA RATON FL
33431-7209
US

IV. Provider business mailing address

2499 GLADES RD SUITE 204
BOCA RATON FL
33431-7209
US

V. Phone/Fax

Practice location:
  • Phone: 561-750-9004
  • Fax: 561-750-9004
Mailing address:
  • Phone: 561-750-9004
  • Fax: 561-750-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0012739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: