Provider Demographics
NPI:1134132954
Name:KRETCHMER, ROBERT ALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALVIN
Last Name:KRETCHMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 80TH ST SO
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3035
Mailing Address - Country:US
Mailing Address - Phone:651-459-3145
Mailing Address - Fax:651-254-7353
Practice Address - Street 1:7430 80TH ST SO
Practice Address - Street 2:SUITE 203
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3035
Practice Address - Country:US
Practice Address - Phone:651-459-3145
Practice Address - Fax:651-254-7353
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist