Provider Demographics
NPI:1285040980
Name:TSO, THEODORE V (DMD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:V
Last Name:TSO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:V
Other - Last Name:TSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:216-445-9409
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-2527
Practice Address - Country:US
Practice Address - Phone:626-215-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL127131223P0700X
CADDS1001231223P0700X
OH30.0273721223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics