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Individual

DONALD L THEOPHILUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1105 S 13TH ST, NORFOLK, NE 68701-5767
(402) 371-1360
(402) 371-1278
Mailing address
PO BOX 1203, NORFOLK, NE 68702-1203
(402) 371-1360
(402) 371-1278

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3996
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
05839
BCBS
NE
Enumeration date
11/13/2006
Last updated
07/08/2007
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