Healthcare Provider Details

I. General information

NPI: 1558066118
Provider Name (Legal Business Name): JORDAN WILLIAM TRETBAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13TH ADC, 1ST DENTAL BATTALION/NAVAL DENTAL CENTER CAMP PENDLETON BLDG. 13128 14TH STREET
CAMP PENDLETON CA
92055-5221
US

IV. Provider business mailing address

13TH ADC, 1ST DENTAL BATTALION/NAVAL DENTAL CENTER CAMP PENDLETON BLDG. 13128 14TH STREET
CAMP PENDLETON CA
92055-5221
US

V. Phone/Fax

Practice location:
  • Phone: 714-681-6944
  • Fax:
Mailing address:
  • Phone: 714-681-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: