Provider Demographics
NPI:1609993229
Name:PRETEL, ROBERT WILLIAM JR (DDS MSD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:PRETEL
Suffix:JR
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9309 OFFICE PARK CIR
Mailing Address - Street 2:STE 120
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8072
Mailing Address - Country:US
Mailing Address - Phone:916-485-7283
Mailing Address - Fax:
Practice Address - Street 1:1810 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-971-3461
Practice Address - Fax:916-973-9830
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics