Provider Demographics
NPI:1518179639
Name:PHILIP J. BRETZ,D.M.D.,PA.
Entity Type:Organization
Organization Name:PHILIP J. BRETZ,D.M.D.,PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-364-4355
Mailing Address - Street 1:210 LINCOLN AVE.
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-1854
Mailing Address - Country:US
Mailing Address - Phone:207-364-4355
Mailing Address - Fax:207-512-1700
Practice Address - Street 1:210 LINCOLN AVE.
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-1854
Practice Address - Country:US
Practice Address - Phone:207-364-4355
Practice Address - Fax:207-512-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME21101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty