Fallon Madeline Theis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14054 Issued in MN

Practice address

623 S Sibley Ave
Litchfield, MN 55355-3339

Phone

(320) 693-8131

NPI assigned

Jun 21, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Theis Family Dental, PLLC

  • Dental Clinic/Center
  • Hutchinson, MN
  • NPI 1366271975
  NPD Authorized official
• Sibley Dental Suite, PLLC

  • General Practice Dentistry
  • Litchfield, MN
  • NPI 1780738179
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529539200000",
    "number": "1407340524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S GRADE CT SW",
            "city": "HUTCHINSON",
            "state": "MN",
            "postal_code": "553506739",
            "telephone_number": "320-310-8325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 S SIBLEY AVE",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "553553339",
            "telephone_number": "320-693-8131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS",
        "first_name": "FALLON",
        "middle_name": "MADELINE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-21",
        "last_updated": "2018-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Bachman
• Anita M Strei, MD
• Ryan P Swenson, DDS
• Terrence L Tancabel, O.D.
• Bradley Eugene Teske, R.PH.
• Angela Heather Thompson, RN
• Timothy R. Kinsella DC PLLC
• Tomorrow, LLC
• Tomorrow, LLC
• True Compass Counseling LLC

• Dentist in Litchfield, MN
• Providers in Litchfield, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.