Individual
DR. JOHN P THEOBALD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1200 S AIR DEPOT BLVD, I, MIDWEST CITY, OK 73110-4848
(405) 733-8136
Mailing address
10140 SE 55TH ST, OKLAHOMA CITY, OK 73150-4531
(405) 733-4154
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4270
OK
Other
Enumeration date
05/28/2006
Last updated
07/08/2007
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