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General NPI Number Information
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NPI Number | 1326530486
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Entity Type | Individual
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Provider Name | BRAD C THEURER DDS
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Gender | Male
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 1340 N 600 E STE 1
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City | LOGAN
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State | UT
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Zip | 84341-2475
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Country | US
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Telephone | 435-752-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 531 S 1080 E
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City | SMITHFIELD
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State | UT
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Zip | 84335
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Country | US
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Telephone | 435-760-9258
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Fax |
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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 | 10842216-9922
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License Number State | UT
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