| Louis V. Theodos, Dmd Oral And Maxillofacial Surgery, Llc | |
|
52 Federal Rd Suite 2a Danbury CT 06810-6162 | |
| (203) 790-6288 | |
| (203) 790-7617 |
| Full Name | Louis V. Theodos, Dmd Oral And Maxillofacial Surgery, Llc |
|---|---|
| Speciality | Dentist |
| Location | 52 Federal Rd, Danbury, Connecticut |
| Authorized Official Name and Position | Louis Vincent Theodos (OWNER/SOLE PROPRIETOR) |
| Authorized Official Contact | 2037906288 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Louis V. Theodos, Dmd Oral And Maxillofacial Surgery, Llc 52 Federal Rd Suite 2a Danbury CT 06810-6162 Ph: (203) 790-6288 | Louis V. Theodos, Dmd Oral And Maxillofacial Surgery, Llc 52 Federal Rd Suite 2a Danbury CT 06810-6162 Ph: (203) 790-6288 |
| NPI Number | 1164835583 |
|---|---|
| Provider Enumeration Date | 06/03/2014 |
| Last Update Date | 02/27/2015 |
| Medicare PECOS PAC ID | 8628398674 |
|---|---|
| Medicare Enrollment ID | O20150515000025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164835583 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 7113 (Connecticut) | Primary |
| Provider Name | Louis V Theodos |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1982616074 PECOS PAC ID: 1951571165 Enrollment ID: I20110825000727 |
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