Provider Demographics
NPI:1558479790
Name:THEKEN, JAMES E JR (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:THEKEN
Suffix:JR
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 1:9011 HWY 34 SOUTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474
Mailing Address - Country:US
Mailing Address - Phone:903-356-3017
Mailing Address - Fax:
Practice Address - Street 1:9011 HWY 34 SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474
Practice Address - Country:US
Practice Address - Phone:903-356-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist