Provider Demographics
NPI:1467514810
Name:THIEL, DONALD CORBIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CORBIN
Last Name:THIEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 PRINCETON PIKE
Mailing Address - Street 2:BLDG.1,SUITEH
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2300
Mailing Address - Country:US
Mailing Address - Phone:609-882-9088
Mailing Address - Fax:
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:BLDG.1,SUITEH
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:609-882-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1013328001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice