Individual
KONSTANTINE DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3278 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-2778
Mailing address
3278 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-2778
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401414848
VA
390200000X
Student in an Organized Health Care Education/Training Program
0401414848
VA
Other
Enumeration date
03/08/2016
Last updated
09/05/2023
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