Jesse Alan Thietten, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901020778 Issued in MI

Practice address

1667 Cochrane Cir BLDG 7495
Fort Carson, CO 80913-4603

Phone

(719) 526-5537

NPI assigned

Aug 27, 2012

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1699023580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 N ROYAL ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223141530",
            "telephone_number": "248-872-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1667 COCHRANE CIR BLDG 7495",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134603",
            "telephone_number": "719-526-5537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIETTEN",
        "first_name": "JESSE",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-27",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Lynn Taylor, RD
• Charles Lane Taylor, MD
• Cory Nathan Taylor, PA-C
• James Teel, DPT
• Jodi Lynn Terpenning, CNM
• April L. Thomas, FNP
• Melyssa Angela Thomas
• Quimberly Thomas, NP-C
• Darin B Thompson, MD
• Randall Eugene Thompson, RN

• General Practice Dentistry in Fort Carson, CO
• Providers in Fort Carson, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.