Dietrich, Craig B
Dietrich, Craig B is an sole proprietor health care provider with primary practice located at 904 Brookdale Street , Martinsville VA 24112. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Dietrich, Craig B can be contacted via phone (276) 632-0010.Contact Information
Primary practice address
904 Brookdale Street
Martinsville VA 24112
Phone: (276) 632-0010
Fax: (276) 632-0010
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 0401007580 | Virginia |
Profile Details
| NPI number | 1275648347 |
|---|---|
| LBN Legal business name | Dietrich, Craig B |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 20th, 2006 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275648347 | NPPES |
| Virginia | MEDICAID | 9181139 | |
| Virginia | MEDICAID | 108674 |
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