Provider Demographics
NPI:1275591752
Name:THIEBERG, RACHEL HOPE (DDS MS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:HOPE
Last Name:THIEBERG
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:HOPE
Other - Last Name:FROMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 COOPER DR # 160
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3970
Mailing Address - Country:US
Mailing Address - Phone:972-941-9363
Mailing Address - Fax:972-941-9364
Practice Address - Street 1:600 COOPER DR # 160
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3970
Practice Address - Country:US
Practice Address - Phone:972-941-9363
Practice Address - Fax:972-941-9364
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191223X0400X
TX9951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics