Gary E Theobald, DMD
NPI #1467597104 in Broken Arrow, Oklahoma
Provider Information
- NPI Number
- 1467597104
- Entity Type
- Individual
- Name
- Gary E Theobald, DMD
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Dentist - General Practice
- Credential
- DMD
- Enumeration Date
- Feb 20, 2007
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 2619 S ELM PL
- City
- Broken Arrow
- State
- Oklahoma
- ZIP Code
- 74012-7878
- Phone
- (918) 455-0811
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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