Provider Demographics
NPI:1124174032
Name:THIEL, JEREMY (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:THIEL
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 1:825 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4157
Mailing Address - Country:US
Mailing Address - Phone:614-846-7828
Mailing Address - Fax:614-846-0227
Practice Address - Street 1:825 HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4157
Practice Address - Country:US
Practice Address - Phone:614-846-7828
Practice Address - Fax:614-846-0227
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0223891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice