John William Cretzmeyer Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8144 Issued in MN

Practice address

1099 Moore Lake Dr E
Fridley, MN 55432-5153

Phone

(763) 586-9988

Fax

(763) 586-9977

NPI assigned

Nov 7, 2005

Last updated

Jan 20, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr John W Cretzmeyer Jr DDS PA

  dba Dentistry for the Entire Family

  • Dentist
  • Fridley, MN
  • NPI 1730346636
  NPD (past) Authorized official
• Bauman Ventures LLC

  dba Dentistry for the Entire Family

  • Dental Clinic/Center
  • Fridley, MN
  • NPI 1710716147
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295481600000",
    "number": "1164403267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1099 MOORE LAKE DR E",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325153",
            "telephone_number": "763-586-9988",
            "fax_number": "763-586-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1099 MOORE LAKE DR E",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325153",
            "telephone_number": "763-586-9988",
            "fax_number": "763-586-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRETZMEYER",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2011-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "8144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arath Josue Coronado
• Andrew John Cozadd, PA-C
• Robin C Crandall, M.D.
• Creative Dream Early Intervention LLC
• Crescent Hearth LLC
• Sandra Crossett, MS LP
• Allison Cuddihy, OTR/L
• Ashley Culhane, ATC
• Aidan Joseph Culloton
• Michael Curran, LADC

• General Practice Dentistry in Fridley, MN
• Providers in Fridley, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; 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.

Verify at the official NPI Registry.