Active NPI
Nicholas Dietz
- Dentist
- San Diego, CA
National Provider Identifier
1598549107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 109191
- Practice address
- 3737 Murphy Canyon Rd
San Diego, CA 92123-4454 - Phone
- (858) 694-0790
- NPI assigned
- Aug 23, 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 | 109191 | CA | Primary |
Addresses
Primary practice location
3737 Murphy Canyon Rd
San Diego, CA 92123-4454
Mailing address
4329 Loma Riviera CT
San Diego, CA 92110-5504
Phone (541) 390-3966
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20240131004114 | CA | Order and Referring Only - Dentist | 7315390804 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109191 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692748800000",
"number": "1598549107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4329 LOMA RIVIERA CT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921105504",
"telephone_number": "541-390-3966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3737 MURPHY CANYON RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234454",
"telephone_number": "858-694-0790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZ",
"first_name": "NICHOLAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-08-23",
"last_updated": "2023-08-23",
"certification_date": "2023-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "109191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.