Provider Demographics
NPI:1740298546
Name:THEOPHILUS, JULIUS ROMON (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:ROMON
Last Name:THEOPHILUS
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 1:2908 W 37TH CIR STE 206
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-8113
Mailing Address - Country:US
Mailing Address - Phone:605-941-1701
Mailing Address - Fax:
Practice Address - Street 1:#1 HOSPITAL ROAD
Practice Address - Street 2:QUENTIN N. BURDICK PHS HOSPITAL
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0160
Practice Address - Country:US
Practice Address - Phone:701-477-8439
Practice Address - Fax:701-477-8402
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist