Active NPI
Kaitlin Cronan Dietz, DDS
- General Practice Dentistry
- Joplin, MO
National Provider Identifier
1710116934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3981
- Practice address
- 530 S Maiden LN
Joplin, MO 64801-3084 - Phone
- (417) 782-0080
- Fax
- (417) 782-0096
- NPI assigned
- Jul 9, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3981 | AR | Primary |
Addresses
Primary practice location
530 S Maiden LN
Joplin, MO 64801-3084
Mailing address
1603 SW Regional Airport Blvd
Bentonville, AR 72712-7359
Phone (479) 715-9428
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151229001004 | AR | Order and Referring Only - Oral Surgery | 3779884226 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3981 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450656000000",
"number": "1710116934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1603 SW REGIONAL AIRPORT BLVD",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727127359",
"telephone_number": "479-715-9428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 S MAIDEN LN",
"city": "JOPLIN",
"state": "MO",
"postal_code": "648013084",
"telephone_number": "417-782-0080",
"fax_number": "417-782-0096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZ",
"first_name": "KAITLIN",
"middle_name": "CRONAN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-09",
"last_updated": "2015-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AR",
"license": "3981",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joplin, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2015; 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.