Provider Demographics
NPI:1881034551
Name:THEURER, ANDREW B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:THEURER
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 1:12465 S FORT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9021
Mailing Address - Country:US
Mailing Address - Phone:801-576-1167
Mailing Address - Fax:
Practice Address - Street 1:12465 S FORT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9021
Practice Address - Country:US
Practice Address - Phone:801-576-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8718432-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice