Individual
DR. DEAN DUVAL DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
609 E SIBLEY BLVD, DOLTON, IL 60419-2648
(708) 849-4400
Mailing address
609 E SIBLEY BLVD, DOLTON, IL 60419-2648
(708) 849-4400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019020148
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42-1578802
EID - PLEASANT DENTAL LLC
IL
Enumeration date
10/12/2006
Last updated
11/28/2016
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