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1154175818
NIKOLAS KENNETH DIEDERICH
MYRTLE BEACH, SC
NPI
1154175818
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
122300000X Dentist
(Licence: UT 13909577-9923)
Enumeration Date
2024-04-17
Last Update Date
2024-04-17
Business Address
Dr. NIKOLAS KENNETH DIEDERICH DMD
1267 38TH AVE N SPC 219
MYRTLE BEACH, SC 29577-1313
Phone number: 843-491-5963
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Mailing Address
Dr. NIKOLAS KENNETH DIEDERICH DMD
1894 E WAGSTAFF DR
SALT LAKE CITY, UT 84117-5165
Phone number: 801-931-8322
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