Individual
DENNIS DIETZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
203 SIERRA PT, GLEN CARBON, IL 62034-1346
(618) 971-8827
Mailing address
203 SIERRA PT, GLEN CARBON, IL 62034-1346
(618) 971-8827
Taxonomy
Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
—
—
Other
Enumeration date
11/30/2022
Last updated
11/30/2022
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