Provider Demographics
NPI:1467718577
Name:GREGORY C. THIEL, DDS, PLLC
Entity Type:Organization
Organization Name:GREGORY C. THIEL, DDS, PLLC
Other - Org Name:THIEL PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER.
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:THIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-892-0013
Mailing Address - Street 1:3775 S. CAPITAL OF TEXAS HWY.
Mailing Address - Street 2:SUITE 292
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7908
Mailing Address - Country:US
Mailing Address - Phone:512-892-0013
Mailing Address - Fax:512-892-3359
Practice Address - Street 1:3775 S. CAPITAL OF TEXAS HWY.
Practice Address - Street 2:SUITE 292
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7908
Practice Address - Country:US
Practice Address - Phone:512-892-0013
Practice Address - Fax:512-892-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165426102Medicaid