Healthcare Provider Details

I. General information

NPI: 1427171768
Provider Name (Legal Business Name): MICHAEL CRAIG KRETCHMER D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10931 STRICKLAND RD SUITE 101
RALEIGH NC
27615-2085
US

IV. Provider business mailing address

10931 STRICKLAND RD SUITE 101
RALEIGH NC
27615-2085
US

V. Phone/Fax

Practice location:
  • Phone: 919-844-7140
  • Fax: 919-845-6065
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number07090
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: