MEDICARE: DR. MICHAEL CRAIG KRETCHMER D.D.S., M.S.

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	1223P0300X	Periodontics	07090	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07090	OTHER	NC	DENTIST LICENSE NUMBER

General Provider Information

NPI Number	:	1427171768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL CRAIG KRETCHMER D.D.S., M.S.

Provider Business Mailing Address
First Line	:	10931 STRICKLAND RD
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27615-2085
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10931 STRICKLAND RD
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27615-2085
Country	:	US
Telephone Number	:	919-844-7140
Fax Number	:	919-845-6065

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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