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NPI Code Detail

MEDICARE: DR. JAMES LOUIS KRETZSCHMAR DDS

MEDICARE: DR. JAMES LOUIS KRETZSCHMAR DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry8214NC

General Provider Information

NPI Number : 1083709588
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES LOUIS KRETZSCHMAR DDS
Provider Business Mailing Address
First Line : 6900 ALDEN DR.
Second Line : 90TH MEDICAL GROUP
City : F.E. WARREN AFB
State : WY
Zip : 82005-3914
Country : US
Telephone Number : 307-773-1846
Fax Number :
Provider Business Practice Location Address
First Line : 6900 ALDEN DR
Second Line :
City : FT WARREN AFB
State : WY
Zip : 82005-3906
Country : US
Telephone Number : 307-773-1846
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 01/14/2009

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