Active NPI
Thomas Dietrich, DMD
- Dentist
- Riverview, FL
National Provider Identifier
1245914167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 28061
- Practice address
- 13123 US Highway 301 S
Riverview, FL 33578-7401 - Phone
- (813) 397-8969
- NPI assigned
- Jun 12, 2023
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 28061 | FL | Primary |
Addresses
Primary practice location
13123 US Highway 301 S
Riverview, FL 33578-7401
Mailing address
5001 Bridge St Apt 4502
Tampa, FL 33611-3272
Phone (772) 418-5471
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231004000076 | FL | Order and Referring Only - Dentist | 7618321068 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28061 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dentists of Riverview, PA | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Riverview, FL
- NPI 1376015180
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686528000000",
"number": "1245914167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5001 BRIDGE ST APT 4502",
"city": "TAMPA",
"state": "FL",
"postal_code": "336113272",
"telephone_number": "772-418-5471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13123 US HIGHWAY 301 S",
"city": "RIVERVIEW",
"state": "FL",
"postal_code": "335787401",
"telephone_number": "813-397-8969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "THOMAS",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-12",
"last_updated": "2023-06-12",
"certification_date": "2023-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "28061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.