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Individual

CRAIG CARL THIEDE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
13522 NEWPORT AVE STE 109, TUSTIN, CA 92780-3707
(714) 730-6767
(714) 730-1161
Mailing address
13522 NEWPORT AVE STE 109, TUSTIN, CA 92780-3707
(714) 730-6767
(714) 730-1161

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
40892
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
B40892-01
CA
Enumeration date
12/08/2006
Last updated
03/15/2022
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