Provider Demographics
NPI:1164403267
Name:CRETZMEYER, JOHN WILLIAM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:CRETZMEYER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1099 MOORE LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5153
Mailing Address - Country:US
Mailing Address - Phone:763-586-9988
Mailing Address - Fax:763-586-9977
Practice Address - Street 1:1099 MOORE LAKE DR E
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5153
Practice Address - Country:US
Practice Address - Phone:763-586-9988
Practice Address - Fax:763-586-9977
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN81441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice