Kristian Clymer Dietz, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2009014596 Issued in MO

Practice address

1603 SW Regional Airport Blvd
Bentonville, AR 72713-7300

Phone

(479) 715-4277

NPI assigned

Jul 9, 2009

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 AR

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

Specialty

Dentist

Education

Virginia Commonwealth Univ School of Dentistry, 2009

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Ozark Snoring and Sleep Apnea PLLC

  • Customized Equipment (DME)
  • Bentonville, AR
  • NPI 1538892930

  Dentist

  Medicare reassignment NPD
• Kristian C. Dietz, DDS, PLLC

  • General Practice Dentistry
  • Bentonville, AR
  • NPI 1952723215
  NPD (past) Authorized official
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Carthage, MO
  • NPI 1992995120
  NPD (past)

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775520000000",
    "number": "1154550382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1603 SW REGIONAL AIRPORT BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727137300",
            "telephone_number": "479-715-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 SW REGIONAL AIRPORT BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727137300",
            "telephone_number": "479-715-4277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1603 SW Regional Airport Blvd",
            "address_purpose": "LOCATION",
            "city": "Bentonville",
            "state": "AR",
            "postal_code": "727137300",
            "country_code": "US",
            "telephone_number": "479-339-0081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIETZ",
        "first_name": "KRISTIAN",
        "middle_name": "CLYMER",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-09",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2009014596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devon Davasher, LCSW PLLC
• Wenelle R. Dewitt, LPTA
• Dialysis Centers of Northwest Arkansas, LLC
• Dialysis Centers of Northwest Arkansas, LLC
• Rodger C Dickinson Jr., M.D.
• Jaime Dietzen, LCSW
• Joseph Michael Dik, D.C.
• Tessa Dilbeck, RBT
• Brittany Nicole Dillard, DNP, APRN, FNP-BC
• Jennifer Dillard, O.D.

• Dentist in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Dentist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.