Provider Demographics
NPI:1336179902
Name:THEIN, DAVID J (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:THEIN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W 95TH ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-3364
Mailing Address - Country:US
Mailing Address - Phone:913-341-4141
Mailing Address - Fax:913-341-4432
Practice Address - Street 1:5000 W 95TH ST
Practice Address - Street 2:SUITE 270
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-3364
Practice Address - Country:US
Practice Address - Phone:913-341-4141
Practice Address - Fax:913-341-4432
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics