Dietrich Dental Services PA

Primary specialty

DentistTaxonomy code 122300000X

License

DN9422 Issued in FL

Legal business name

DIETRICH DENTAL SERVICES PA

Practice address

17178 Toledo Blade Blvd
Port Charlotte, FL 33954-2626

Phone

(941) 625-7877

Fax

(941) 625-4349

NPI assigned

Dec 16, 2011

Organization subpart

No

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

Authorized official

Name

Dr. John Louis Dietrich, DDS

Title

President

Phone

(941) 625-7877

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theodora Kalonaros Dietrich, D.D.S.

  • Dentist
  • Port Charlotte, FL
  • NPI 1144435090
  NPD (past)

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

{
    "created_epoch": "1323993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323993600000",
    "number": "1003185240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17178 TOLEDO BLADE BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339542626",
            "telephone_number": "941-625-7877",
            "fax_number": "941-625-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17178 TOLEDO BLADE BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339542626",
            "telephone_number": "941-625-7877",
            "fax_number": "941-625-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIETRICH DENTAL SERVICES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-16",
        "last_updated": "2011-12-16",
        "status": "A",
        "authorized_official_last_name": "DIETRICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-625-7877",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN9422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pallavi Ravi Devaguptapu, O.T
• Laura M Devore, PMHNP
• Denise Marie Di Luv
• Jennifer Dibert, MSN APRN FNP-BC
• Edward Dickerson, RPH
• John Louis Dietrich, D.D.S.
• Theodora Kalonaros Dietrich, D.D.S.
• Daniel B Dietz, DDS,MS
• Paul L Digiorgi, MD
• Christina Dill, BCBA

• Dentist in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; 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.