Individual
RUSSELL T THALER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD,MS
Contact information
Practice address
5757 MONCLOVA RD, SUITE 12, MAUMEE, OH 43537-1863
(419) 893-0253
Mailing address
9024 CEDAR BEND RD, SYLVANIA, OH 43560-9394
(419) 340-8455
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
30-023000
OH
Other
Enumeration date
05/18/2007
Last updated
11/30/2011
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