Michael Wayne Dietz, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS2839 Issued in TN

Practice address

3397 Middleford Dr
Cookeville, TN 38506-6120

Phone

(931) 372-1647

Fax

(931) 537-2215

NPI assigned

Nov 30, 2005

Last updated

Oct 25, 2021By the provider in NPPES

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

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1326022872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3397 MIDDLEFORD DR",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385066120",
            "telephone_number": "931-372-1647",
            "fax_number": "931-537-2215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3397 MIDDLEFORD DR",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385066120",
            "telephone_number": "931-372-1647",
            "fax_number": "931-537-2215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZ",
        "first_name": "MICHAEL",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS2839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "DS2839",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "2383",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor D Dennison, MD
• Raygn Denton, MSSW
• Sally Depriest, R.N.
• Diabetes & Geriatrics Specialist LLC
• John M Dickson, APRN
• Christopher Parish Dill, M.D.
• Lacie Dillon, PA-C
• Lauren B Dillon, PHARMD
• Lisa Marie Dillon, FNP-C
• Vicky Dillon, FNP

• General Practice Dentistry in Cookeville, TN
• Providers in Cookeville, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.

Verify at the official NPI Registry.