| NPI | 1003259797 |
|---|---|
| Professional Name | TIMOTHY MCMICHAEL THEISEN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS038461) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS038461) |
| 1223E0200X Dentist Endodontics (Licence: PA DS038461) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS038461) | |
| 1223P0700X Dentist Prosthodontics (Licence: PA DS038461) | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2021-08-09 |