Thomas J Dietrich, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

21924 Issued in OH

Practice address

4774 Munson St NW
Suite 102
Canton, OH 44718-3634

Phone

(330) 494-6653

Fax

(330) 494-6630

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2022 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Dietrich & Associates Oral and Maxillofacial Surgery, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Canton, OH
  • NPI 1528153533
  NPD (past) Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283212800000",
    "number": "1841301942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4774 MUNSON ST NW",
            "address_2": "SUITE 102",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183634",
            "telephone_number": "330-494-6653",
            "fax_number": "330-494-6630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4774 MUNSON ST NW",
            "address_2": "SUITE 102",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183634",
            "telephone_number": "330-494-6653",
            "fax_number": "330-494-6630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "THOMAS",
        "middle_name": "J",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "21924",
            "primary": true
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "OH",
            "license": "21924",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Curtis Didato, LSW
• Danielle Elizabeth Didyk, CRNA
• Julie A Diehl
• Faye Dieringer
• Dietrich & Associates Oral and Maxillofacial Surgery, Inc.
• Different Abilities Transportation and Care
• Peter E Digiacomo, DO
• Ashley Michele Dilbeck
• Gracie Ann Dillard
• Racquel I Dillard, CT

• Oral and Maxillofacial Surgery (Dentist) in Canton, OH
• Providers in Canton, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.