Provider Demographics
NPI:1699943613
Name:VICTOR S. DIETZ, D.M.D.
Entity type:Organization
Organization Name:VICTOR S. DIETZ, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-872-0011
Mailing Address - Street 1:223 WALNUT ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-7500
Mailing Address - Country:US
Mailing Address - Phone:508-872-0011
Mailing Address - Fax:508-820-3031
Practice Address - Street 1:223 WALNUT ST
Practice Address - Street 2:SUITE 22
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7500
Practice Address - Country:US
Practice Address - Phone:508-872-0011
Practice Address - Fax:508-820-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty