Most Relevant Information
Provider Data
| NPI Number: | 1003259797 |
| Provider Name: | TIMOTHY MCMICHAEL THEISEN DMD |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | DS038461 |
Most Important Dates
| Enumeration Date: | 04/11/2013 |
| Last Updated: | 08/09/2021 |
Provider Practice Location
4330 PEACH ST
ERIE
PA
165091443
Practice Location Phone/Fax
| Phone: | 8143156209 |
| Fax: | 8143156303 |
Provider Mailing Location
4330 PEACH ST
ERIE
PA
165091443
Provider Mailing Phone/Fax
| Phone: | 8143156209 |
| Fax: | 8143156303 |