Provider Demographics
NPI:1184793275
Name:RETZER, JAMES PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:RETZER
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:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-0679
Mailing Address - Country:US
Mailing Address - Phone:505-281-2622
Mailing Address - Fax:505-286-6413
Practice Address - Street 1:#2 BIRCH RD
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-0679
Practice Address - Country:US
Practice Address - Phone:505-281-2622
Practice Address - Fax:505-286-6413
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM001492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist