Kielan Dietrich, DMD
NPI 1992690812ActiveIndividual· Dentist· Tahlequah, OK
Dentist (DMD) in Tahlequah, Oklahoma, trained at At Still University, Arizona School of Dentistry & Oral Hlth (class of 2025). Enrolled in Medicare as practitioner - dentist.
Overview
| NPI | 1992690812 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DMD |
| Sole proprietor | No |
| NPI issued | Jun 11, 2025 |
| Last updated in NPPES | Mar 25, 2026 |
| Certified by provider | Mar 25, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | 8114 | OK |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Dentist (TX) |
|---|
Education and affiliations
| Medical school | At Still University, Arizona School of Dentistry & Oral Hlth |
|---|---|
| Graduation year | 2025 |
| Medicare specialty | Dentist |
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
Other Dentist providers in Tahlequah
- 1003131459
- 1083963003
- 1962738328
- 1194888594
- 1487596482
- 1295184448
- 1922090695
- 1508929092
- 1588493530
- 1154483774
- 1528118007
- 1619070752