Individual
DR. JASON ALLEN THIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
105 N PARK LN, MISHICOT, WI 54228-9537
(920) 755-2336
(920) 755-4930
Mailing address
105 N PARK LN, MISHICOT, WI 54228-9537
(920) 755-2336
(920) 755-4930
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5096-015
WI
Other
Enumeration date
08/11/2006
Last updated
07/08/2007
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