Provider Demographics
NPI:1235104613
Name:THEURER, MICHAEL CLAIR (DDS,MS,PC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLAIR
Last Name:THEURER
Suffix:
Gender:M
Credentials:DDS,MS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 W AVENUE J
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2830
Mailing Address - Country:US
Mailing Address - Phone:661-949-2290
Mailing Address - Fax:661-945-4754
Practice Address - Street 1:1629 W AVENUE J
Practice Address - Street 2:SUITE 108
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2830
Practice Address - Country:US
Practice Address - Phone:661-949-2290
Practice Address - Fax:661-945-4754
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics