MEDICARE: DR. CHRISTOPHER THIELEN D.D.S.

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	30 016842	OH

General Provider Information

NPI Number	:	1659498582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER THIELEN D.D.S.

Provider Business Mailing Address
First Line	:	6780 HEARNE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1003
Country	:	US
Telephone Number	:	513-574-7896
Fax Number	:

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	07/08/2007

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