Provider Demographics
NPI:1790142065
Name:DR. THEODORE G SCHROPP
Entity Type:Organization
Organization Name:DR. THEODORE G SCHROPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SCHROPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-255-2700
Mailing Address - Street 1:4521 N WICKHAM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7108
Mailing Address - Country:US
Mailing Address - Phone:321-255-2700
Mailing Address - Fax:321-255-5380
Practice Address - Street 1:4521 N WICKHAM RD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7108
Practice Address - Country:US
Practice Address - Phone:321-255-2700
Practice Address - Fax:321-255-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12963261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental