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General NPI Number Information
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NPI Number | 1790866382
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Entity Type | Individual
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Provider Name | JAMES G DIETTE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 722 POST RD STE 301
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City | DARIEN
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State | CT
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Zip | 06820-4731
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Country | US
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Telephone | 203-656-0404
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Fax | 203-662-9245
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Provider Business Mailing Address
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Address Line | 20 OUTLOOK DR
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City | DARIEN
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State | CT
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Zip | 06820-5615
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Country | US
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Telephone | 203-656-0404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5428
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License Number State | CT
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