Individual
DR. CHARLES W THIE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
310 W LOSEY ST, 375TH DENTAL SQUADRON, SCOTT AFB, IL 62225-5250
(618) 256-6667
Mailing address
2266 CALGARY DR, BELLEVILLE, IL 62221-5102
(618) 222-7368
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
05654
IA
Other
Enumeration date
09/22/2005
Last updated
07/08/2007
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