Provider Demographics
NPI:1750397840
Name:THERIOT, ROY PERRY (DDS)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:PERRY
Last Name:THERIOT
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 1:941 S HAVANA ST
Mailing Address - Street 2:STE 200
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3019
Mailing Address - Country:US
Mailing Address - Phone:303-341-5313
Mailing Address - Fax:303-363-1272
Practice Address - Street 1:941 S HAVANA ST
Practice Address - Street 2:STE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3042
Practice Address - Country:US
Practice Address - Phone:303-341-5313
Practice Address - Fax:303-363-1272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1053851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice