Individual
TODD ERIC THIERER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2500 COMO AVE, SAINT PAUL, MN 55108
(651) 647-2525
(651) 632-8984
Mailing address
8170 33RD AVE S, BLOOMINGTON, MN 55425-4516
(952) 883-5151
(529) 883-5160
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13000
MN
1223G0001X
General Practice Dentistry
041625-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01354916
—
NY
01
—
7876
BLUE SHIELD GROUP NUMBER
—
Enumeration date
08/23/2006
Last updated
09/11/2018
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