Provider Demographics
NPI:1093011215
Name:DENGLER, THEODORE JOSEPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOSEPH
Last Name:DENGLER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 KINGS MILL PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1883
Mailing Address - Country:US
Mailing Address - Phone:919-522-0818
Mailing Address - Fax:
Practice Address - Street 1:8700 KINGS MILL PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1883
Practice Address - Country:US
Practice Address - Phone:919-522-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice