MEDICARE: CHRISTOPHER THIELEN, D.D.S. LLC

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	261QD0000X	Dental Clinic/Center	30-016842	OH

General Provider Information

NPI Number	:	1154531341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER THIELEN, D.D.S. LLC

Provider Business Mailing Address
First Line	:	4254 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-2048
Country	:	US
Telephone Number	:	513-541-5655
Fax Number	:	513-541-5695

Provider Business Practice Location Address
First Line	:	4254 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-2048
Country	:	US
Telephone Number	:	513-541-5655
Fax Number	:	513-541-5695

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER THIELEN
Credential	:	D.D.S.
Telephone Number	:	513-541-5655

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/15/2007

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