Healthcare Provider Details

I. General information

NPI: 1912830241
Provider Name (Legal Business Name): THEODORE JAMES LEFEBER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TEEGARDEN ST
LA PORTE IN
46350-3175
US

IV. Provider business mailing address

1285 E 400 S
LA PORTE IN
46350-9335
US

V. Phone/Fax

Practice location:
  • Phone: 888-580-1060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number12015045A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: