MEDICARE: DR. MARY THOLEN DDS

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	1223G0001X	General Practice Dentistry	17870	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346466265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY THOLEN DDS

Provider Business Mailing Address
First Line	:	1616 BEALL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3446
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 BEALL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3446
Country	:	US
Telephone Number	:	832-443-9508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	04/13/2015

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