Provider Demographics
NPI:1740381698
Name:DAVID A. THEIS, D.D.S., P.A.
Entity Type:Organization
Organization Name:DAVID A. THEIS, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:THEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-789-5100
Mailing Address - Street 1:1674 PROVIDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-4961
Mailing Address - Country:US
Mailing Address - Phone:386-789-5100
Mailing Address - Fax:386-789-5116
Practice Address - Street 1:1674 PROVIDENCE BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-4961
Practice Address - Country:US
Practice Address - Phone:386-789-5100
Practice Address - Fax:386-789-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 57611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty