Provider Demographics
NPI:1952303505
Name:THIEL, GREGORY CHRISTOPHER (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CHRISTOPHER
Last Name:THIEL
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:9015 MOUNTAIN RIDGE DR
Mailing Address - Street 2:HOUSTON BLDG STE 320
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7370
Mailing Address - Country:US
Mailing Address - Phone:512-346-9771
Mailing Address - Fax:512-346-8111
Practice Address - Street 1:9015 MOUNTAIN RIDGE DR
Practice Address - Street 2:HOUSTON BLDG STE 320
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7370
Practice Address - Country:US
Practice Address - Phone:512-346-9771
Practice Address - Fax:512-346-8111
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX216481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88D976OtherBCBS
TX1671031OtherUNITED CONCORDIA