Provider Demographics
NPI:1699832055
Name:VERSHEY, THEODORE (DDS)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:VERSHEY
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 1:2005 8TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1707
Mailing Address - Country:US
Mailing Address - Phone:218-263-8348
Mailing Address - Fax:218-263-5898
Practice Address - Street 1:2005 8TH AVE E
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1707
Practice Address - Country:US
Practice Address - Phone:218-263-8348
Practice Address - Fax:218-263-5898
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNM84181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM8418OtherLICENSE NUMBER