Provider Demographics
NPI:1013930767
Name:LERNER, THEODORE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:R
Last Name:LERNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:THEODORE
Other - Middle Name:R
Other - Last Name:LERNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2499 GLADES RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7209
Mailing Address - Country:US
Mailing Address - Phone:561-750-9004
Mailing Address - Fax:561-750-9004
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7209
Practice Address - Country:US
Practice Address - Phone:561-750-9004
Practice Address - Fax:561-750-9004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00127391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics