Provider Demographics
NPI:1699904540
Name:THEURER, DANIEL JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAY
Last Name:THEURER
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 1:1955 S 1300 E
Mailing Address - Street 2:SUITE L-2
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3658
Mailing Address - Country:US
Mailing Address - Phone:801-486-9649
Mailing Address - Fax:801-486-9640
Practice Address - Street 1:1955 S 1300 E
Practice Address - Street 2:SUITE L-2
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3658
Practice Address - Country:US
Practice Address - Phone:801-486-9649
Practice Address - Fax:801-486-9640
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7394687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist