Individual
DR. RYAN JOHN THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1041 E HWY 152, MUSTANG, OK 73064-5117
(405) 518-4011
Mailing address
1041 E HWY 152, MUSTANG, OK 73064-5117
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6302
OK
Other
Enumeration date
07/11/2011
Last updated
07/11/2011
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