Individual
DR. MICHAEL JONATHAN THEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
17901 NW 5TH STREET, SUITE # 101, PEMBROKE PINES, FL 33029
(954) 437-2222
(954) 437-2244
Mailing address
790 E BROWARD BLVD, UNIT 2403, FORT LAUDERDALE, FL 33301
(516) 359-9194
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0442000331
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN26758
FL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
0442000331
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2018
Last updated
05/21/2024
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