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NPI Code Detail

MEDICARE: DR. JAMES DAVID THEISS DMD

MEDICARE:  DR. JAMES DAVID THEISS  DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistKY5558KY

General Provider Information

NPI Number : 1891999884
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES DAVID THEISS DMD
Provider Business Mailing Address
First Line : 1118 S FT THOMAS AVE
Second Line :
City : FT THOMAS
State : KY
Zip : 41075
Country : US
Telephone Number : 859-781-3090
Fax Number : 859-781-3135
Provider Business Practice Location Address
First Line : 1118 S FT THOMAS AVE
Second Line :
City : FT THOMAS
State : KY
Zip : 41075
Country : US
Telephone Number : 859-781-3090
Fax Number : 859-781-3135
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 07/08/2007

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Directions to “ DR. JAMES DAVID THEISS DMD” Practice Location

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