John Louis Dietrich, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN9422 Issued in FL

Practice address

17178 Toledo Blade Blvd
Port Charlotte, FL 33954-2626

Phone

(941) 625-7877

Fax

(941) 625-4349

NPI assigned

May 14, 2007

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

Medicare fee-for-service enrollment

Enrolled in FL

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

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780899674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17178 TOLEDO BLADE BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339542626",
            "telephone_number": "941-625-7877",
            "fax_number": "941-625-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17178 TOLEDO BLADE BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339542626",
            "telephone_number": "941-625-7877",
            "fax_number": "941-625-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "JOHN",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN9422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura M Devore, PMHNP
• Denise Marie Di Luv
• Jennifer Dibert, MSN APRN FNP-BC
• Edward Dickerson, RPH
• Dietrich Dental Services PA
• Theodora Kalonaros Dietrich, D.D.S.
• Daniel B Dietz, DDS,MS
• Paul L Digiorgi, MD
• Christina Dill, BCBA
• Brittany Diltz, PTA

• General Practice Dentistry in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• General Practice Dentistry in Florida

• 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.