Provider Demographics
NPI:1013968460
Name:PIETZ, DANIEL MILBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MILBERT
Last Name:PIETZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6577 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1175
Mailing Address - Country:US
Mailing Address - Phone:910-630-6857
Mailing Address - Fax:910-482-5050
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:VETERAN ADMINISTRATION MEDICAL CENTER
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-822-7029
Practice Address - Fax:910-482-5050
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice