Provider Demographics
NPI:1063529659
Name:MARGARET J THIELE DDS PA
Entity type:Organization
Organization Name:MARGARET J THIELE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:J
Authorized Official - Last Name:THIELE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-646-0913
Mailing Address - Street 1:3501 S GARY
Mailing Address - Street 2:
Mailing Address - City:FT. SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903
Mailing Address - Country:US
Mailing Address - Phone:479-646-0913
Mailing Address - Fax:479-646-8844
Practice Address - Street 1:3501 S GARY
Practice Address - Street 2:
Practice Address - City:FT. 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty