Individual
DR. MARC CONEL THEVENIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5270 ELMORE AVE STE 4, DAVENPORT, IA 52807-3437
(563) 209-9000
Mailing address
2095 CLEMENTI LN, AURORA, IL 60503-8579
(909) 810-6292
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019030600
IL
122300000X
Dentist
Primary
DDS-10298
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/09/2011
Last updated
11/27/2024
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