Provider Demographics
NPI:1407013113
Name:MICHAEL C. THEURER DDS,MS,PC
Entity Type:Organization
Organization Name:MICHAEL C. THEURER DDS,MS,PC
Other - Org Name:THEURER ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:661-949-2290
Mailing Address - Street 1:1629 W AVENUE J STE 108
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2851
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty