Provider Demographics
NPI:1215010780
Name:THEIS, DALE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:THEIS
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 1:440 BEECHER ROAD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1797
Mailing Address - Country:US
Mailing Address - Phone:614-855-5828
Mailing Address - Fax:614-855-5827
Practice Address - Street 1:440 BEECHER ROAD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1797
Practice Address - Country:US
Practice Address - Phone:614-855-5828
Practice Address - Fax:614-855-5827
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist