Individual
DR. KIELAN DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
19600 E ROSS ST, TAHLEQUAH, OK 74464-0545
(539) 234-1000
Mailing address
2469 E KAIBAB PL, CHANDLER, AZ 85249-2969
(701) 566-1635
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8114
OK
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/11/2025
Last updated
03/25/2026
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