Theisen, Timothy Mcmichael

Theisen, Timothy Mcmichael is an individual health care provider with primary practice located at 4330 Peach St , Erie PA 16509-1443. He recently has 5 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Endodontics, Dental Providers / Pediatric Dentistry, Dental Providers / Prosthodontics, Dental Providers / Dentist. Dental Providers / Dentist is his primary health care specialty. Theisen, Timothy Mcmichael can be contacted via phone (814) 315-6209.

Contact Information

Primary practice address
4330 Peach St Erie PA 16509-1443
Phone: (814) 315-6209
Fax: (814) 315-6303
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DS038461 Pennsylvania
Dental Providers / Endodontics 1223E0200X DS038461 Pennsylvania
Dental Providers / Pediatric Dentistry 1223P0221X DS038461 Pennsylvania
Dental Providers / Prosthodontics 1223P0700X DS038461 Pennsylvania
Dental Providers / Dentist 122300000X DS038461 Pennsylvania

Profile Details

NPI number 1003259797
LBN Legal business name Theisen, Timothy Mcmichael
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2013
Last updated Aug 9th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003259797 NPPES
New York Other 056582 NYS LICENSE

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