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THOMAS J DIETRICH DDS, MD
NPI 1841301942
Dentist - Oral and Maxillofacial Surgery in Canton, OH

Active since August 31, 2006Opted out of Medicare · through Apr 1, 2028
4774 MUNSON ST NW, SUITE 102, CANTON, OH 44718(330) 494-6653(330) 494-6630 Get Directions Write a Review

NPPES record last updated: August 31, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Thomas J Dietrich Dds, Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THOMAS J DIETRICH DDS, MD (NPI 1841301942) is an individual oral and maxillofacial surgery provider in Canton, Ohio, licensed in Ohio (21924) and active in the NPI registry since August 2006. He has opted out of Medicare through April 1, 2028.

NPPES Registry Identity

NPI1841301942
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameTHOMAS J DIETRICHCredential: DDS, MD
Location Address4774 MUNSON ST NW, SUITE 102Canton, OH 44718-3634
Mailing Address4774 Munson St Nw, Suite 102Canton, OH 44718-3634 · (330) 494-6653 · Fax (330) 494-6630
Phone(330) 494-6653
Fax(330) 494-6630
Sole ProprietorNo
Enumeration DateAugust 31, 2006
Last NPPES UpdateAugust 31, 2010
✔ NPI 1841301942 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in OH · 21924
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Also ListedDentist · Oral and Maxillofacial PathologyTaxonomy 1223P0106X · License 21924 (OH)
4774 MUNSON ST NW, Canton, OH 44718
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Thomas J Dietrich Dds, Md has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2022 through April 1, 2028.

Opt-Out Effective DateApril 1, 2022
Opt-Out In Effect ThroughApril 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PREMIER HEALTH AND WELLNESS CENTER, LLC
Family Medicine
4774 MUNSON ST NW
CANTON, OH 44718
Stark County (330) 754-4431
DR. PHILIP GEROW CAMERON DC
Chiropractor
4774 MUNSON ST NW, #302
CANTON, OH 44718
Stark County (330) 494-0422
FEDORKO CHIROPRACTIC HEALTH CTR
Chiropractor
4774 MUNSON ST NW, SUITE 302
CANTON, OH 44718
Stark County (330) 494-0422
MARK R. GRUBB, MD, INC.
Durable Medical Equipment & Medical Supplies
4774 MUNSON ST NW, SUITE 302
CANTON, OH 44718
Stark County (330) 966-9328
DR. DANIA KAFRI DDS, MSD
Dentist (Endodontics)
4774 MUNSON ST NW, SUITE 304
CANTON, OH 44718
Stark County (330) 497-5331
WILLIAMS FAMILY DENTAL GROUP INC
Clinic/Center (Dental)
4774 MUNSON ST NW, SUITE 303
CANTON, OH 44718
Stark County (330) 497-7700
DR. MICHAEL G GRIMES MD
Family Medicine
4774 MUNSON ST NW, SUITE 401
CANTON, OH 44718
Stark County (330) 754-4431
MARK R. GRUBB, MD, INC.
Orthopaedic Surgery
4774 MUNSON ST NW, SUITE 302
CANTON, OH 44718
Stark County (330) 966-9328

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Thomas Dietrich's NPI number?

The NPI number for Thomas Dietrich is 1841301942. It was assigned to this individual provider in the NPPES registry on August 31, 2006.

Where is Thomas Dietrich located?

Thomas Dietrich practices at 4774 Munson St NW Suite 102, Canton, OH 44718. The listed phone number is (330) 494-6653.

What is Thomas Dietrich's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Thomas Dietrich enrolled in Medicare?

No. Thomas Dietrich has opted out of Medicare through April 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Thomas Dietrich was last updated on August 31, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.