Provider Demographics
NPI:1962522813
Name:THALER DENTAL
Entity type:Organization
Organization Name:THALER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:THALER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-942-7216
Mailing Address - Street 1:1226 PLEASANT VALLEY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4742
Mailing Address - Country:US
Mailing Address - Phone:814-942-7216
Mailing Address - Fax:
Practice Address - Street 1:1226 PLEASANT VALLEY BLVD STE A
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4742
Practice Address - Country:US
Practice Address - Phone:814-942-7216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030236L1223G0001X
PADS029854L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty