# DIETRICH & ASSOCIATES ORAL AND MAXILLOFACIAL SURGERY, INC.

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

## Provider details

- **NPI number:** 1528153533
- **Authorized official:** THOMAS JOSEPH DIETRICH DDS, MD (OWNER/PRESIDENT)
- **Authorized official phone:** (330) 494-6653

## Contact information

- **Practice address:** 4774 MUNSON ST NW, SUITE 102, CANTON, OH 44718
- **Practice address phone:** (330) 494-6653
- **Practice address fax:** (330) 494-6630
- **Mailing address:** 4774 MUNSON ST NW, SUITE 102, CANTON, OH 44718
- **Mailing address phone:** (330) 494-6653
- **Mailing address fax:** (330) 494-6630

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 21924 | OH | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 01/24/2020