Provider Demographics
NPI:1003937004
Name:OPPERMAN, THEODORE DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:DAVID
Last Name:OPPERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:PEN ARGYL
Mailing Address - State:PA
Mailing Address - Zip Code:18072-9707
Mailing Address - Country:US
Mailing Address - Phone:610-863-9212
Mailing Address - Fax:
Practice Address - Street 1:962 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:PEN ARGYL
Practice Address - State:PA
Practice Address - Zip Code:18072-9707
Practice Address - Country:US
Practice Address - Phone:610-863-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017781L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice