GARY E THEOBALD

BROKEN ARROW, OK
NPI1467597104
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: OK  3804)
Enumeration Date2007-02-20
Last Update Date2007-07-08
Business Address
-- GARY E THEOBALD dmd
2619 S ELM PL
BROKEN ARROW, OK 74012-7878
Phone number: 918-455-0811
Mailing Address
-- GARY E THEOBALD dmd
2619 S ELM PL
BROKEN ARROW, OK 74012-7878
Phone number: 918-455-0811
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