Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 30-01-5741 | OH |
NPI | 1053425504 |
---|---|
Provider Name | Dr. Thomas S Dietrich |
First Address | Alliance, OH 44601-3521 |
Second Address | Alliance, OH 44601-3521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 08/07/2007 |