Active NPI
Philip Dietel
- Dentist
- Dayton, OH
National Provider Identifier
1699263277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30.025802
- Practice address
- 1 Wyoming St
Dayton, OH 45409-2711 - Phone
- (937) 208-3844
- NPI assigned
- Apr 29, 2018
- Sex
- Male
- Sole proprietor
- No
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 | 30.025802 | OH | Primary |
Addresses
Primary practice location
1 Wyoming St
Dayton, OH 45409-2711
Mailing address
5800 E Lake Dr Apt 407
Lisle, IL 60532-4600
Phone (952) 201-7486
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20180726001739 | OH | Order and Referring Only - Dentist | 3971850652 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30.025802 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566259200000",
"number": "1699263277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5800 E LAKE DR APT 407",
"city": "LISLE",
"state": "IL",
"postal_code": "605324600",
"telephone_number": "952-201-7486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WYOMING ST",
"city": "DAYTON",
"state": "OH",
"postal_code": "454092711",
"telephone_number": "937-208-3844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETEL",
"first_name": "PHILIP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-29",
"last_updated": "2019-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30.025802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.