Provider Demographics
NPI:1346262581
Name:DIETZ, ANDREW J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:DIETZ
Suffix:
Gender:M
Credentials:DDS
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Other - Credentials:
Mailing Address - Street 1:17 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE # 8
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1299
Mailing Address - Country:US
Mailing Address - Phone:856-547-8664
Mailing Address - Fax:856-541-5560
Practice Address - Street 1:17 WHITE HORSE PIKE
Practice Address - Street 2:SUITE # 8
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1299
Practice Address - Country:US
Practice Address - Phone:856-547-8664
Practice Address - Fax:856-541-5560
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ181461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics