Individual
DR. KELLI DANIELLE THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
205 E HARCOURT RD, ANGOLA, IN 46703-7131
(260) 665-5767
Mailing address
205 E HARCOURT RD, ANGOLA, IN 46703-7131
(260) 665-5767
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
120111974A
IN
Other
Enumeration date
06/11/2013
Last updated
09/18/2013
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