Provider Demographics
NPI:1003994146
Name:ASPER, THERESA C (DDS)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:C
Last Name:ASPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 PARK AVE STE 7-8
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2244
Mailing Address - Country:US
Mailing Address - Phone:541-269-1317
Mailing Address - Fax:541-269-7817
Practice Address - Street 1:375 PARK AVE STE 7-8
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2244
Practice Address - Country:US
Practice Address - Phone:541-269-1317
Practice Address - Fax:541-269-7817
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD78411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD7841OtherDENTIST