Healthcare Provider Details

I. General information

NPI: 1578562773
Provider Name (Legal Business Name): GREGORY L THEIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 CHAPEL DR SUITE G
FINDLAY OH
45840-1331
US

IV. Provider business mailing address

1816 CHAPEL DR SUITE G
FINDLAY OH
45840-1331
US

V. Phone/Fax

Practice location:
  • Phone: 419-422-8972
  • Fax: 419-422-8973
Mailing address:
  • Phone: 419-422-8972
  • Fax: 419-422-8973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30021577
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: