Active NPI
Olivia Nicole Dietrich, DMD
- General Practice Dentistry
- Elmhurst, IL
National Provider Identifier
1033845540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.033914
- Practice address
- 333 W 1St St
Elmhurst, IL 60126-2641 - Phone
- (630) 833-5110
- NPI assigned
- Jul 27, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.033914 | IL | Primary |
Addresses
Primary practice location
333 W 1St St
Elmhurst, IL 60126-2641
Mailing address
14 Bay Dr
New Fairfield, CT 06812-3401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033914 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658880000000",
"number": "1033845540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 BAY DR",
"city": "NEW FAIRFIELD",
"state": "CT",
"postal_code": "068123401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 W 1ST ST",
"city": "ELMHURST",
"state": "IL",
"postal_code": "601262641",
"telephone_number": "630-833-5110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "OLIVIA",
"middle_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-27",
"last_updated": "2022-07-27",
"certification_date": "2022-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.033914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.