MEDICARE: DR. ROBERT ALVIN KRETCHMER 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
1	122300000X	Dentist	8886	MN

General Provider Information

NPI Number	:	1134132954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALVIN KRETCHMER DDS

Provider Business Mailing Address
First Line	:	7430 80TH ST SO
Second Line	:	SUITE 203
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-3035
Country	:	US
Telephone Number	:	651-459-3145
Fax Number	:	651-254-7353

Provider Business Practice Location Address
First Line	:	7430 80TH ST SO
Second Line	:	SUITE 203
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-3035
Country	:	US
Telephone Number	:	651-459-3145
Fax Number	:	651-254-7353

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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