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DR. KIELAN DIETRICH DMD
NPI 1992690812
Dentist in Tahlequah, OK

Active since June 11, 2025PECOS Enrolled
19600 E ROSS ST, TAHLEQUAH, OK 74464(539) 234-1000 Get Directions Write a Review

NPPES record last updated: March 25, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 25, 2026, Jun 11, 2025 (2 updates tracked since 2025).

About Dr. Kielan Dietrich Dmd NPPES

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

DR. KIELAN DIETRICH DMD (NPI 1992690812) is an individual dentist in Tahlequah, Oklahoma, licensed in Oklahoma (8114) and active in the NPI registry since June 2025. She is enrolled in Medicare PECOS and is a graduate of At Still University, Arizona School Of Dentistry & Oral Hlth (2025).

NPPES Registry Identity

NPI1992690812
Entity TypeIndividualFemale
Primary Taxonomy122300000X
Provider Legal NameDR. KIELAN DIETRICHCredential: DMD
Location Address19600 E ROSS STTahlequah, OK 74464-0545
Mailing Address2469 E Kaibab PlChandler, AZ 85249-2969 · (701) 566-1635
Phone(539) 234-1000
Sole ProprietorNo
Medical School CMSAt Still University, Arizona School Of Dentistry & Oral HlthGraduated 2025
Enumeration DateJune 11, 2025
Last NPPES UpdateMarch 25, 20262 updates tracked since enumeration
NPPES CertifiedMarch 25, 2026
✔ NPI 1992690812 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in OK · 8114
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
19600 E ROSS ST, Tahlequah, OK 74464
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kielan Dietrich Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID941789689
PECOS Enrollment IDI20260212000600
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 74464 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.46 typical visit price
range $53.00 – $162.61
Typical copayment $20.61 (range $13.25 – $40.65)
Most-billed visit code 99203
Established Patient
$66.48 typical visit price
range $16.68 – $132.40
Typical copayment $16.62 (range $4.17 – $33.10)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

LINDSEY MICHELLE STROTHER PA
Physician Assistant
19600 E ROSS ST
TAHLEQUAH, OK 74464
Cherokee County (919) 434-8500
DR. SARAH ANNE PEARSON DO
Student in an Organized Health Care Education/Training Program
19600 E ROSS ST
TAHLEQUAH, OK 74464
Cherokee County (539) 302-4172
ANN NGUYEN D.P.M
Podiatrist
19600 E ROSS ST
TAHLEQUAH, OK 74464
Cherokee County (539) 234-1000
MIKAYLA JAMESON
Occupational Therapy Assistant
19600 E ROSS ST
TAHLEQUAH, OK 74464
Cherokee County (539) 234-1900
THOMAS CRAIG BEEN DDS
Dentist (General Practice)
19600 E ROSS ST
TAHLEQUAH, OK 74464
Cherokee County (539) 234-1000
KIMBERLY ANN WATSON NP-C
Nurse Practitioner
19600 E ROSS ST
TAHLEQUAH, OK 74464
Cherokee County (539) 234-1000
DESTINY SPRING DANIEL PHARM.D.
Pharmacist
19600 E ROSS ST
TAHLEQUAH, OK 74464
Cherokee County (539) 234-1000
BRITTANY N HUGGINS
Peer Specialist
19600 E ROSS ST
TAHLEQUAH, OK 74464
Cherokee County (539) 234-1000

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 Kielan Dietrich's NPI number?

The NPI number for Kielan Dietrich is 1992690812. It was assigned to this individual provider in the NPPES registry on June 11, 2025.

Where is Kielan Dietrich located?

Kielan Dietrich practices at 19600 E Ross St, Tahlequah, OK 74464. The listed phone number is (539) 234-1000.

What is Kielan Dietrich's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Kielan Dietrich enrolled in Medicare?

Yes. Kielan Dietrich is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kielan Dietrich was last updated on March 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months 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.