Provider Demographics
NPI:1285040980
Name:TSO, THEODORE V (DMD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:V
Last Name:TSO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:V
Other - Last Name:TSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:627 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:627 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2527
Practice Address - Country:US
Practice Address - Phone:626-799-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1001231223P0700X, 1223P0700X
MADL127131223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics