| NPI | 1528153533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS JOSEPH DIETRICH Owner/President 330-494-6653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 21924) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-01-24 |