NPIMap

Organization Active NPI

Michael B. Dietrich, D.M.D.,P.C.

  • Dentist
  • Bridgeton, MO
National Provider Identifier
1467563213
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
14818 Issued in MO
Legal business name
MICHAEL B. DIETRICH, D.M.D.,P.C.
Practice address
3439 Bridgeland Dr
Bridgeton, MO 63044-2604
Phone
(314) 291-2777
Fax
(314) 291-9873
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Michael Brian Dietrich, D.M.D.NPI 1750492500
Title
President
Phone
(314) 291-2777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 14818 MO Primary

Addresses

Primary practice location

3439 Bridgeland Dr
Bridgeton, MO 63044-2604

Mailing address

3439 Bridgeland Dr
Bridgeton, MO 63044-2604
Phone (314) 291-2777

National Provider Directory

National Provider Directory

Locations

3439 Bridgeland Dr
Bridgeton, MO 63044
Phone (314) 278-9375

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467563213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3439 BRIDGELAND DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442604",
            "telephone_number": "314-291-2777",
            "fax_number": "314-291-9873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3439 BRIDGELAND DR",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442604",
            "telephone_number": "314-291-2777",
            "fax_number": "314-291-9873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL B. DIETRICH, D.M.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIETRICH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-291-2777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MO",
            "license": "14818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.