Mark Benjamin Thiele, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D13533 Issued in MN

Practice address

301 State Ave SW
Warroad, MN 56763-2623

Phone

(218) 386-1048

Fax

(218) 386-1049

NPI assigned

Jun 9, 2015

Last updated

Apr 22, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Warroad Family Dentistry, LTD

  dba Lake Family Dental

  • General Practice Dentistry
  • Warroad, MN
  • NPI 1497745400
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1073994653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "WARROAD",
            "state": "MN",
            "postal_code": "567630490",
            "telephone_number": "218-386-1048",
            "fax_number": "218-386-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 STATE AVE SW",
            "city": "WARROAD",
            "state": "MN",
            "postal_code": "567632623",
            "telephone_number": "218-386-1048",
            "fax_number": "218-386-1049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIELE",
        "first_name": "MARK",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-09",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northern Lights Family Dentistry,PC
• Rachel Michele Pearce, DNP FNP-C
• Red Lake Band of Chippewa Indians (Red Lake Emergency Response Program (W))
• Roseau Warroad Eye Clinic PA (Warroad eye Clinic)
• Roseau/Warroad Eye Clinic, P.a.
• Michael Ernest Thiele, DDS
• James R. Thompson, PHARM D
• Thrifty Drug Stores Inc (Thrifty White Pharmacy #780)
• Up North Physical Therapy (Warroad Physical Therapy)
• Up North Physical Therapy, LLC (Warroad Physical Therapy)

• Dentist in Warroad, MN
• Providers in Warroad, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.