Craig B Dietrich, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401007580 Issued in VA

Practice address

904 Brookdale Street
Martinsville, VA 24112

Phone

(276) 632-0010

Fax

(276) 632-0010

NPI assigned

Aug 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 28, 2016 through Mar 28, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1275648347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4402",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241154402",
            "telephone_number": "276-632-0010",
            "fax_number": "276-632-3936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 BROOKDALE STREET",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "24112",
            "telephone_number": "276-632-0010",
            "fax_number": "276-632-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "CRAIG",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401007580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9181139",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108674",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda B Delport, LPT
• Denture Express of Martinsville, LLC
• Dependable Home Healthcare, LLC
• Nicole Marie Deshon Nelson, DMD
• Terrence Joseph Despot, PTA
• Deshunta Dillard
• Tanell Dillard
• Wyvette Dillard
• Clare Daniel Doss, FNP-C
• Dr Augustine MD & Associates Primary Care Medical Clinic

• General Practice Dentistry in Martinsville, VA
• Providers in Martinsville, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.