Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | AD4179001 | MI |
NPI | 1053578203 |
---|---|
Provider Name | Anthony E Dietz |
First Address | Bloomfield Hills, MI 48304-2374 |
Second Address | Bloomfield Hills, MI 48304-2374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2008 |
Last Update Date | 16/05/2008 |