Organization
J. KELLY THEISEN, D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN KELLY THEISEN D.D.S. (OWNER)
(970) 867-2256
Entity
Organization
Contact information
Practice address
521 E RAILROAD AVENUE, FORT MORGAN, CO 80701-3331
(970) 867-2256
(970) 542-9464
Mailing address
521 E RAILROAD AVENUE, FORT MORGAN, CO 80701-3331
(970) 867-2256
(970) 542-9464
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN00106339
CO
Other
Enumeration date
08/06/2015
Last updated
08/06/2015
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