Provider Demographics
NPI:1265445696
Name:THEODOROU, CHRIST B (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRIST
Middle Name:B
Last Name:THEODOROU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23812 STONEHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4822
Mailing Address - Country:US
Mailing Address - Phone:440-785-1903
Mailing Address - Fax:
Practice Address - Street 1:7259 CENTER ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4907
Practice Address - Country:US
Practice Address - Phone:440-974-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist