Healthcare Provider Details

I. General information

NPI: 1134132954
Provider Name (Legal Business Name): ROBERT ALVIN KRETCHMER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 80TH ST SO SUITE 203
COTTAGE GROVE MN
55016-3035
US

IV. Provider business mailing address

7430 80TH ST SO SUITE 203
COTTAGE GROVE MN
55016-3035
US

V. Phone/Fax

Practice location:
  • Phone: 651-459-3145
  • Fax: 651-254-7353
Mailing address:
  • Phone: 651-459-3145
  • Fax: 651-254-7353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8886
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: