MEDICARE: DR. JOHN ALFRED KRETZSCHMAR D.M.D.

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	7604	CO

General Provider Information

NPI Number	:	1780652289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALFRED KRETZSCHMAR D.M.D.

Provider Business Mailing Address
First Line	:	314 W 5TH AVE
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-1248
Country	:	US
Telephone Number	:	307-256-8397
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 3 BOX 6352
Second Line	:
City	:	APO
State	:	AP
Zip	:	96266
Country	:	KR
Telephone Number	:	82168912886
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JOHN ALFRED KRETZSCHMAR D.M.D.” Practice Location

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