Gary E Theobald, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3804 Issued in OK

Practice address

2619 S Elm PL
Broken Arrow, OK 74012-7878

Phone

(918) 455-0811

Fax

(918) 451-4787

NPI assigned

Feb 20, 2007

Sex

Male

Sole proprietor

Yes

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

Practice roles

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.

• Reusser and Reusser LLC

  • General Practice Dentistry
  • Broken Arrow, OK
  • NPI 1831305580
  NPD (past)

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467597104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 S ELM PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127878",
            "telephone_number": "918-455-0811",
            "fax_number": "918-451-4787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2619 S ELM PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127878",
            "telephone_number": "918-455-0811",
            "fax_number": "918-451-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "GARY",
        "middle_name": "E",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "3804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Griffin Promise
• The Griffin Promise
• The Restorative Pain to Wellness Center, Inc.
• The Spot for Kids
• Adrian Theerman, APRN
• Think Safety, LLC
• Shannon Cheng Tho
• Thomas H Berenson O D P C
• Caleb Thomas
• Carolyn Y Thomas

• General Practice Dentistry in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.