Provider Demographics
NPI:1689695298
Name:THIELMAN, ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:THIELMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 PILOT KNOB RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6647
Mailing Address - Country:US
Mailing Address - Phone:952-423-4414
Mailing Address - Fax:952-423-7174
Practice Address - Street 1:14050 PILOT KNOB RD
Practice Address - Street 2:SUITE 108
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6647
Practice Address - Country:US
Practice Address - Phone:952-423-4414
Practice Address - Fax:952-423-7174
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND85101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice