Individual
DR. MICHAEL WAYNE DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
3397 MIDDLEFORD DR, COOKEVILLE, TN 38506-6120
(931) 372-1647
(931) 537-2215
Mailing address
3397 MIDDLEFORD DR, COOKEVILLE, TN 38506-6120
(931) 372-1647
(931) 537-2215
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS2839
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2383
DENTAL LICENSE
MT
01
—
DS2839
DENTAL LICENSE
TN
Enumeration date
11/30/2005
Last updated
10/25/2021
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