Provider Demographics
NPI:1942603576
Name:THEODUS, DARLENE (RDH)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:THEODUS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6901
Mailing Address - Country:US
Mailing Address - Phone:330-926-5657
Mailing Address - Fax:330-923-6370
Practice Address - Street 1:1867 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6901
Practice Address - Country:US
Practice Address - Phone:330-926-5657
Practice Address - Fax:330-923-6370
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31.008422124Q00000X
OHOHAH.60124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist