Provider Demographics
NPI:1194306662
Name:THIELEN, ROBERT K (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:K
Last Name:THIELEN
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 1:20242 N 76TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6431
Mailing Address - Country:US
Mailing Address - Phone:412-255-4558
Mailing Address - Fax:
Practice Address - Street 1:444 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1220
Practice Address - Country:US
Practice Address - Phone:412-420-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist