Healthcare Provider Details

I. General information

NPI: 1225121957
Provider Name (Legal Business Name): DAVID PHILLIP KRETZSCHMAR D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MILLER ST.
WINSTON SALEM NC
27103
US

IV. Provider business mailing address

717 LANKASHIRE RD.
WINSTON SALEM NC
27106
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2178
  • Fax: 336-716-3997
Mailing address:
  • Phone: 336-716-2178
  • Fax: 336-716-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6837
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: