Provider Demographics
NPI:1134289705
Name:THEODORE J PAULY DDS LTD
Entity Type:Organization
Organization Name:THEODORE J PAULY DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PAULY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-892-8933
Mailing Address - Street 1:1940 W GALENA BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4483
Mailing Address - Country:US
Mailing Address - Phone:630-892-8933
Mailing Address - Fax:630-892-8935
Practice Address - Street 1:1940 W GALENA BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4483
Practice Address - Country:US
Practice Address - Phone:630-892-8933
Practice Address - Fax:630-892-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19010102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty