Active NPI
Clay Cunningham Dietz, D.D.S.
- Endodontics
- Troy, MI
National Provider Identifier
1073643417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 2901018693
- Practice address
- 5877 Livernois Rd
Suite #106
Troy, MI 48098-3100 - Phone
- (248) 828-3636
- NPI assigned
- Mar 6, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 2901018693 | MI | Primary |
Addresses
Primary practice location
5877 Livernois Rd
Suite #106
Troy, MI 48098-3100
Mailing address
3733 Ravena Ave
Royal Oak, MI 48073-6439
Phone (734) 320-9993
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 |
|---|---|---|---|
| 2901018693 | MI | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073643417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3733 RAVENA AVE",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480736439",
"telephone_number": "734-320-9993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5877 LIVERNOIS RD",
"address_2": "SUITE #106",
"city": "TROY",
"state": "MI",
"postal_code": "480983100",
"telephone_number": "248-828-3636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZ",
"first_name": "CLAY",
"middle_name": "CUNNINGHAM",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MI",
"license": "2901018693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.