Individual
DR. CRAIG B DIETRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
904 BROOKDALE STREET, MARTINSVILLE, VA 24112
(276) 632-0010
(276) 632-0010
Mailing address
PO BOX 4402, MARTINSVILLE, VA 24115-4402
(276) 632-0010
(276) 632-3936
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007580
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108674
—
VA
05
—
9181139
—
VA
Enumeration date
08/20/2006
Last updated
07/09/2007
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