| Craig C. Thiede Dds | |
|
13132 Newport Ave Ste 230 Tustin CA 92780-3429 | |
| (714) 730-6767 | |
| (714) 730-1161 |
| Full Name | Craig C. Thiede Dds |
|---|---|
| Speciality | Dentist |
| Location | 13132 Newport Ave Ste 230, Tustin, California |
| Authorized Official Name and Position | Craig Thiede (OFFICE MANAGER) |
| Authorized Official Contact | 7147306767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Craig C. Thiede Dds 13132 Newport Ave Ste 230 Tustin CA 92780-3429 Ph: (714) 730-6767 | Craig C. Thiede Dds 13132 Newport Ave Ste 230 Tustin CA 92780-3429 Ph: (714) 730-6767 |
| NPI Number | 1841892148 |
|---|---|
| Provider Enumeration Date | 11/11/2020 |
| Last Update Date | 02/24/2023 |
| Medicare PECOS PAC ID | 7113392333 |
|---|---|
| Medicare Enrollment ID | O20230331000643 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841892148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Craig C Thiede |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1528127024 PECOS PAC ID: 9234428897 Enrollment ID: I20160520001050 |
| Provider Name | Naman Desai |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1689040115 PECOS PAC ID: 3072988740 Enrollment ID: I20230411001481 |
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