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Individual

THOMAS J DIETRICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS, MD

Contact information

Practice address
4774 MUNSON ST NW, SUITE 102, CANTON, OH 44718-3634
(330) 494-6653
(330) 494-6630
Mailing address
4774 MUNSON ST NW, SUITE 102, CANTON, OH 44718-3634
(330) 494-6653
(330) 494-6630

Taxonomy

Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
21924
OH
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
21924
OH

Other

Enumeration date
08/31/2006
Last updated
08/31/2010
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