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General NPI Number Information
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NPI Number | 1699943613
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Entity Type | Organization
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Legal Business Name | VICTOR S. DIETZ, D.M.D.
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 223 WALNUT ST SUITE 22
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City | FRAMINGHAM
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State | MA
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Zip | 01702-7500
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Country | US
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Telephone | 508-872-0011
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Fax | 508-820-3031
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Provider Business Mailing Address
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Address Line | 223 WALNUT ST SUITE 22
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City | FRAMINGHAM
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State | MA
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Zip | 01702-7500
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Country | US
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Telephone | 508-872-0011
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Fax | 508-820-3031
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICTOR DIETZ
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Credential | D.M.D.
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Telephone | 508-872-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 11059
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License Number State | MA
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