Thiede, Craig Carl
Thiede, Craig Carl is an sole proprietor health care provider with primary practice located at 13522 Newport Ave Ste 109 , Tustin CA 92780-3707. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Thiede, Craig Carl can be contacted via phone (714) 730-6767.Contact Information
Primary practice address
13522 Newport Ave Ste 109
Tustin CA 92780-3707
Phone: (714) 730-6767
Fax: (714) 730-1161
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 40892 | California |
Profile Details
| NPI number | 1528127024 |
|---|---|
| LBN Legal business name | Thiede, Craig Carl |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 8th, 2006 |
| Last updated | Mar 15th, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528127024 | NPPES |
| California | MEDICAID | B40892-01 |
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