Provider Demographics
NPI:1154531341
Name:CHRISTOPHER THIELEN, D.D.S. LLC
Entity type:Organization
Organization Name:CHRISTOPHER THIELEN, D.D.S. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:THIELEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-541-5655
Mailing Address - Street 1:4254 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-2048
Mailing Address - Country:US
Mailing Address - Phone:513-541-5655
Mailing Address - Fax:513-541-5695
Practice Address - Street 1:4254 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-2048
Practice Address - Country:US
Practice Address - Phone:513-541-5655
Practice Address - Fax:513-541-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-016842261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental