DR. Jason P Theobald, DDS
NPI #1285826420 in Great Lakes, Illinois
Provider Information
- NPI Number
- 1285826420
- Entity Type
- Individual
- Name
- DR. Jason P Theobald, DDS
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Dentist - General Practice
- Credential
- DDS
- Enumeration Date
- Aug 13, 2007
- Last Updated
- Oct 10, 2007
Practice Location
- Address
- 3001 6TH ST STE A
- City
- Great Lakes
- State
- Illinois
- ZIP Code
- 60088
- Phone
- (847) 688-2100
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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