Individual
THEODORE LAX
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
103 WASHINGTON ST, ELMIRA, NY 14901-3220
(607) 737-2028
(607) 737-2016
Mailing address
103 WASHINGTON ST, ELMIRA, NY 14901-3220
(607) 737-2028
(607) 737-2016
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
036444-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036444-1
—
NY
Enumeration date
04/10/2006
Last updated
07/09/2007
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