Daniel Martin Dietrich, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS0000003041 Issued in TN

Practice address

1105 W Stone Dr
Kingsport, TN 37660-2558

Phone

(423) 246-7900

Fax

(423) 246-1503

NPI assigned

Nov 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Daniel M Dietrich, DDS, PC

  • General Practice Dentistry
  • Kingsport, TN
  • NPI 1144765793
  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639240328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 W STONE DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376602558",
            "telephone_number": "423-246-7900",
            "fax_number": "423-246-1503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 W STONE DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376602558",
            "telephone_number": "423-246-7900",
            "fax_number": "423-246-1503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "DANIEL",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS0000003041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "2008832",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle J Dickall
• Debra D Dickens, RN
• Ernest Dickson, PT
• Heather Jeanette Dickson, PMHNP
• Paul Diers, PA-C
• Kelli Lynn Dillon, BSW
• Bradley Bishop Diminick, DDS
• Marin Dimitrov, MD
• Marcie Dingus, PHARMD
• Brittany Dixon

• General Practice Dentistry in Kingsport, TN
• Providers in Kingsport, 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 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.