Provider Demographics
NPI:1619076775
Name:THEROUX, CHRISTINE CAROL (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:CAROL
Last Name:THEROUX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18801 E MAIN STREET
Mailing Address - Street 2:SUITE #130
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134
Mailing Address - Country:US
Mailing Address - Phone:303-840-3379
Mailing Address - Fax:303-840-3751
Practice Address - Street 1:18801 E MAIN STREET
Practice Address - Street 2:SUITE #130
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:303-840-3379
Practice Address - Fax:303-840-3379
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist