Provider Demographics
NPI:1881950723
Name:THIELE, MARGARET J (DDS)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:J
Last Name:THIELE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 GARY ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5927
Mailing Address - Country:US
Mailing Address - Phone:479-646-0913
Mailing Address - Fax:479-646-8844
Practice Address - Street 1:3501 SOUTH GARY
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-646-0913
Practice Address - Fax:479-646-8844
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist