Provider Demographics
NPI:1942315221
Name:POPE, THEODORE RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:RICHARD
Last Name:POPE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:R
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:573 W DAVID PKWY
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1977
Mailing Address - Country:US
Mailing Address - Phone:937-294-5205
Mailing Address - Fax:937-836-7901
Practice Address - Street 1:16 W WENGER RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2724
Practice Address - Country:US
Practice Address - Phone:937-832-2087
Practice Address - Fax:937-836-7901
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300143181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics