Provider Demographics
NPI:1578562773
Name:THEIS, GREGORY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:THEIS
Suffix:
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 1:1816 CHAPEL DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1331
Mailing Address - Country:US
Mailing Address - Phone:419-422-8972
Mailing Address - Fax:419-422-8973
Practice Address - Street 1:1816 CHAPEL DR
Practice Address - Street 2:SUITE G
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1331
Practice Address - Country:US
Practice Address - Phone:419-422-8972
Practice Address - Fax:419-422-8973
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist