Kevin L Theroux, D.D.S,M.S.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Lonetree, CO
NPI 1902807977 · NPPES record last updated Jan 5, 2015
Key facts
- NPI
- 1902807977
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 7495 (CO)
- Practice address
- 10450 Park Meadows Dr
Lonetree, CO 80124-5530 - Phone
- (303) 779-0565
- Fax
- (303) 790-9376
- NPI assigned
- Aug 2, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 14, 2015 through Dec 14, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7495 | CO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Total Orthodontics Professional LLP | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 7495 | CO | Yes |
Addresses
Primary practice location
10450 Park Meadows Dr
Lonetree, CO 80124-5530
Mailing address
10450 Park Meadows Dr
#300
Lonetree, CO 80124-5529
Phone (303) 779-0565
Other providers in Lonetree, CO
- Nevin Thomas Sebastian
- Ashley Eileen Spooner
- Harlan A Stueven
- Susan Savage MD PC
- Therapeutic Relief Inc.
- Sarah Caitlin Treharne
- Ultimate Health Chiropractic Lone Tree
- Vincent Vein Center Denver PC
- Vincent Vein Center Denver,PC
- Vista Neuromonitoring, LLC
All providers in Lonetree, CO · Orthodontics and Dentofacial Orthopedics Dentistry in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.