Provider Demographics
NPI:1124152798
Name:THALER, ROLAND CONRAD (DDS)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:CONRAD
Last Name:THALER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2405
Mailing Address - Country:US
Mailing Address - Phone:352-378-2233
Mailing Address - Fax:352-375-7507
Practice Address - Street 1:3500 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2405
Practice Address - Country:US
Practice Address - Phone:352-378-2233
Practice Address - Fax:352-375-7507
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 34411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84441OtherBCBS OF FL PROVIDER #