Individual
DR. GREGORY M DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
314 SUSAN DRIVE, NORMAL, IL 61761
(309) 827-5437
(309) 265-0288
Mailing address
314 SUSAN DRIVE, NORMAL, IL 61761
(309) 827-5437
(309) 265-0288
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019027386
IL
Other
Enumeration date
02/11/2009
Last updated
05/28/2021
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