Provider Demographics
NPI:1801097589
Name:SCHROCK, THEODORE STRAUB (DMD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:STRAUB
Last Name:SCHROCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 ANGLERS DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487
Mailing Address - Country:US
Mailing Address - Phone:970-879-0817
Mailing Address - Fax:970-879-0870
Practice Address - Street 1:505 ANGLERS DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-879-0817
Practice Address - Fax:970-879-0870
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice