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General NPI Number Information
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NPI Number | 1225173172
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Entity Type | Individual
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Provider Name | RONALD G. THEISS DDS, MAGD
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1302 RAGUET
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City | NACOGDOCHES
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State | TX
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Zip | 75965
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Country | US
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Telephone | 936-564-7240
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Fax | 936-564-2731
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Provider Business Mailing Address
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Address Line | PO BOX 632897
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City | NACOGDOCHES
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State | TX
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Zip | 75963-2897
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Country | US
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Telephone | 936-564-7240
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Fax | 936-564-2731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15459
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License Number State | TX
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