Provider Demographics
NPI:1285891010
Name:THEODORE, JAMES W (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:THEODORE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 ACCESS RD STE 26
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5232
Mailing Address - Country:US
Mailing Address - Phone:781-255-1919
Mailing Address - Fax:781-255-8992
Practice Address - Street 1:89 ACCESS RD STE 26
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5232
Practice Address - Country:US
Practice Address - Phone:781-255-1919
Practice Address - Fax:781-255-8992
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice