MEDICARE: MARGARET J THIELE DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2906	AR

General Provider Information

NPI Number	:	1063529659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARGARET J THIELE DDS PA

Provider Business Mailing Address
First Line	:	3501 S GARY
Second Line	:
City	:	FT. SMITH
State	:	AR
Zip	:	72903
Country	:	US
Telephone Number	:	479-646-0913
Fax Number	:	479-646-8844

Provider Business Practice Location Address
First Line	:	3501 S GARY
Second Line	:
City	:	FT. SMITH
State	:	AR
Zip	:	72903
Country	:	US
Telephone Number	:	479-646-0913
Fax Number	:	479-646-8844

Authorized Official
Title or Position	:	OWNER
Name	:	MISS MARGARET J THIELE
Credential	:	DDS
Telephone Number	:	479-646-0913

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	03/27/2012

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