Provider Demographics
NPI:1194833574
Name:THIEL, JO ANN (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JO ANN
Middle Name:
Last Name:THIEL
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4695 N COLONY BLVD
Mailing Address - Street 2:104
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3302
Mailing Address - Country:US
Mailing Address - Phone:972-625-0213
Mailing Address - Fax:972-624-1988
Practice Address - Street 1:4695 N COLONY BLVD
Practice Address - Street 2:104
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-3302
Practice Address - Country:US
Practice Address - Phone:972-625-0213
Practice Address - Fax:972-624-1988
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice