Individual
DR. JOHN KELLY THEISEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
521 E RAILROAD AVE, FORT MORGAN, CO 80701-3331
(970) 867-2256
(970) 542-9464
Mailing address
521 E RAILROAD AVE, FORT MORGAN, CO 80701-3331
(970) 867-2256
(970) 542-9464
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
106339
CO
Other
Enumeration date
07/11/2005
Last updated
07/08/2007
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