Healthcare Provider Details

I. General information

NPI: 1265223465
Provider Name (Legal Business Name): ANVI A. DIETRICH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E ALLEGHENY AVE FL 2
PHILADELPHIA PA
19134-4427
US

IV. Provider business mailing address

400 WALNUT ST APT 7G
PHILADELPHIA PA
19106-3741
US

V. Phone/Fax

Practice location:
  • Phone: 215-282-8000
  • Fax:
Mailing address:
  • Phone: 215-390-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045137
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: