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General NPI Number Information
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NPI Number | 1467718577
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Entity Type | Organization
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Legal Business Name | GREGORY C. THIEL, DDS, PLLC
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 3775 S. CAPITAL OF TEXAS HWY. SUITE 292
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City | AUSTIN
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State | TX
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Zip | 78704-7908
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Country | US
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Telephone | 512-892-0013
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Fax | 512-892-3359
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Provider Business Mailing Address
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Address Line | 3775 S. CAPITAL OF TEXAS HWY. SUITE 292
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City | AUSTIN
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State | TX
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Zip | 78704-7908
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Country | US
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Telephone | 512-892-0013
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Fax | 512-892-3359
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Authorized Official
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Title or Position | OWNER.
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Name | DR. GREGORY C THIEL
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Credential | DDS
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Telephone | 512-892-0013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 21648
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License Number State | TX
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