Provider Demographics
NPI:1962797829
Name:SHILLE, THEODORE RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:RICHARD
Last Name:SHILLE
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 1:3525 W OXFORD AVE UNIT G-3
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3115
Mailing Address - Country:US
Mailing Address - Phone:303-315-6150
Mailing Address - Fax:720-259-4559
Practice Address - Street 1:3525 W OXFORD AVE UNIT G-3
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3115
Practice Address - Country:US
Practice Address - Phone:303-315-6150
Practice Address - Fax:720-259-4559
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.000105131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60886374Medicaid