Provider Demographics
NPI:1386372639
Name:THEODORY, MAJD (DDS)
Entity type:Individual
Prefix:DR
First Name:MAJD
Middle Name:
Last Name:THEODORY
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 1:25779 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2524
Mailing Address - Country:US
Mailing Address - Phone:626-290-6827
Mailing Address - Fax:
Practice Address - Street 1:1461 FORD ST STE 101
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3908
Practice Address - Country:US
Practice Address - Phone:909-793-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist