# DANIEL M DIETRICH, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144765793
- **Authorized official:** WENDY THOMPSON (BUSINESS ASSISTANT)
- **Authorized official phone:** (423) 246-7900

## Contact information

- **Practice address:** 1105 W STONE DR, KINGSPORT, TN 37660-2558
- **Practice address phone:** (423) 246-7900
- **Practice address fax:** (423) 246-1503
- **Mailing address:** 1105 W STONE DR, KINGSPORT, TN 37660-2558
- **Mailing address phone:** (423) 246-7900
- **Mailing address fax:** (423) 246-1503

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3041 | TN | Yes |
| 1223G0001X | General Practice Dentistry | 5285 | TN | — |

## Other

- **Enumeration date:** 01/05/2017
- **Last updated:** 01/05/2017