| J. Kelly Theisen, D.d.s. | |
|
521 E Railroad Avenue Fort Morgan CO 80701-3331 | |
| (970) 867-2256 | |
| (970) 542-9464 |
| Full Name | J. Kelly Theisen, D.d.s. |
|---|---|
| Speciality | Dentist |
| Location | 521 E Railroad Avenue, Fort Morgan, Colorado |
| Authorized Official Name and Position | John Kelly Theisen (OWNER) |
| Authorized Official Contact | 9708672256 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Kelly Theisen, D.d.s. 521 E Railroad Avenue Fort Morgan CO 80701-3331 Ph: (970) 867-2256 | J. Kelly Theisen, D.d.s. 521 E Railroad Avenue Fort Morgan CO 80701-3331 Ph: (970) 867-2256 |
| NPI Number | 1871979393 |
|---|---|
| Provider Enumeration Date | 08/06/2015 |
| Last Update Date | 08/06/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871979393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DEN00106339 (Colorado) | Primary |
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