Provider Demographics
NPI:1841317435
Name:THEE, JOHN H (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:THEE
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 1:933 OLEANDER WAY S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2151
Mailing Address - Country:US
Mailing Address - Phone:727-347-3777
Mailing Address - Fax:727-343-5023
Practice Address - Street 1:933 OLEANDER WAY S
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-2151
Practice Address - Country:US
Practice Address - Phone:727-347-3777
Practice Address - Fax:727-343-5023
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
67829OtherBLUE CROSS BLUE SHIELD