Provider Demographics
NPI:1609952464
Name:THALER, DONALD CHARLES
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CHARLES
Last Name:THALER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:CHARLES
Other - Last Name:THALER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7750 BRAYTON TRL
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-6300
Mailing Address - Country:US
Mailing Address - Phone:440-543-2661
Mailing Address - Fax:440-543-2661
Practice Address - Street 1:34586 LAKESHORE BLVD.
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095
Practice Address - Country:US
Practice Address - Phone:440-946-7878
Practice Address - Fax:440-946-7878
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300171191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0546798Medicaid