Active NPI
James Louis Kretzschmar, DDS
- General Practice Dentistry
- Ft Warren Afb, WY
National Provider Identifier
1083709588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8214
- Practice address
- 6900 Alden Dr
Ft Warren Afb, WY 82005-3906 - Phone
- (307) 773-1846
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160204001099 | TX | Order and Referring Only - Dentist | 1153625520 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8214 | NC | MD | Speech-Language Pathologist |
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8214 | NC | Primary |
Addresses
Primary practice location
6900 Alden Dr
Ft Warren Afb, WY 82005-3906
Mailing address
6900 Alden Dr.
90TH Medical Group
F.E. Warren Afb, WY 82005-3914
Phone (307) 773-1846
NPI Registry JSON
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231891200000",
"number": "1083709588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6900 ALDEN DR.",
"address_2": "90TH MEDICAL GROUP",
"city": "F.E. WARREN AFB",
"state": "WY",
"postal_code": "820053914",
"telephone_number": "307-773-1846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 ALDEN DR",
"city": "FT WARREN AFB",
"state": "WY",
"postal_code": "820053906",
"telephone_number": "307-773-1846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRETZSCHMAR",
"first_name": "JAMES",
"middle_name": "LOUIS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2009-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "8214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Warren Afb, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.