Andrew Dietrich, D.M.D., M.S., P.A.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

17914 Issued in FL

Practice address

330 E Highland Dr
Lakeland, FL 33813-1727

Phone

(863) 644-0430

NPI assigned

Jan 10, 2012

Last updated

Jan 10, 2012By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

Locations

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.

• Dradak Enterprises

  dba Smile Cove Pediatric Dentistry

  • Pediatric Dentistry
  • Brandon, FL
  • NPI 1801672050
  NPD Authorized official
• Adak Enterprises PLLC

  dba Dietrich Kelso Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lakeland, FL
  • NPI 1467194431
  NPD
• Adak-2 Enterprises

  dba Smile Cove Pediatric Dentisty

  • Dental Clinic/Center
  • Tampa, FL
  • NPI 1861190480
  NPD

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326153600000",
    "number": "1922378785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E HIGHLAND DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338131727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E HIGHLAND DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338131727",
            "telephone_number": "863-644-0430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S., P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-10",
        "last_updated": "2012-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "17914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haydee Dickason
• Timothy James Dickason, M.D.
• Rebecca Dickerson
• Jazmine Dicristo
• Nichole Didley, DPM
• Digestive Diseases Care for All LLC
• Kyle Dillon
• John Angelo Dilullo, MD
• Brittany Dimatteo
• Melany Dimbath, RBT

• Orthodontics and Dentofacial Orthopedics Dentistry in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.