Provider Demographics
NPI:1104012939
Name:THEODOSIS, STEVEN PAUL (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:PAUL
Last Name:THEODOSIS
Suffix:
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 1:28365 DAVIS PARKWAY
Mailing Address - Street 2:SUITE 206 FAMILY FIRST DENTAL LLC
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555
Mailing Address - Country:US
Mailing Address - Phone:630-836-8995
Mailing Address - Fax:630-836-8996
Practice Address - Street 1:28365 DAVIS PARKWAY
Practice Address - Street 2:SUITE 206 FAMILY FIRST DENTAL LLC
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555
Practice Address - Country:US
Practice Address - Phone:630-836-8995
Practice Address - Fax:630-836-8996
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist