Fred W Dietrich, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1698 Issued in AR

Practice address

206 Van Buren St NW
Camden, AR 71701-3931

Phone

(870) 836-6802

Fax

(870) 836-6803

NPI assigned

Aug 2, 2006

Last updated

Jul 8, 2007By 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

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356358170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 VAN BUREN ST NW",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717013931",
            "telephone_number": "870-836-6802",
            "fax_number": "870-836-6803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 VAN BUREN ST NW",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717013931",
            "telephone_number": "870-836-6802",
            "fax_number": "870-836-6803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "FRED",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "1698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristi Dean, RN
• William D Dedman, MD
• Velma Defee, BS
• Dawn Deffenbaugh
• Amy Deluca, MD
• Diversicare Leasing Corp. (Ouachita Nursing and Rehabilitation Center)
• Al Gregory Dodds, LPC
• Kiley Jane Doherty
• Caitlin Dolive
• Anita Elaine Dorey

• General Practice Dentistry in Camden, AR
• Providers in Camden, AR by specialty
• General Practice Dentistry in Arkansas

• 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.
• 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.