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General NPI Number Information
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NPI Number | 1528127024
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Entity Type | Individual
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Provider Name | CRAIG CARL THIEDE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 13522 NEWPORT AVE STE 109
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City | TUSTIN
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State | CA
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Zip | 92780-3707
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Country | US
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Telephone | 714-730-6767
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Fax | 714-730-1161
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Provider Business Mailing Address
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Address Line | 13522 NEWPORT AVE STE 109
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City | TUSTIN
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State | CA
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Zip | 92780-3707
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Country | US
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Telephone | 714-730-6767
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Fax | 714-730-1161
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 40892
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License Number State | CA
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