Samuel Lee Kretzschmar Jr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN 13915 Issued in FL

Practice address

4301 N Wickham Rd
Suite 9
Melbourne, FL 32935-2400

Phone

(321) 242-2236

Fax

(321) 751-6072

NPI assigned

Feb 16, 2007

Last updated

Jul 8, 2007By 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 FL

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

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447394077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 N WICKHAM RD",
            "address_2": "SUITE 9",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329352400",
            "telephone_number": "321-242-2236",
            "fax_number": "321-751-6072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 N WICKHAM RD",
            "address_2": "SUITE 9",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329352400",
            "telephone_number": "321-242-2236",
            "fax_number": "321-751-6072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRETZSCHMAR",
        "first_name": "SAMUEL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 13915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Mitchell Kreher, DDS
• Barry M. Krein, D.O.
• Alexis Krell, M.A. CCC-SLP
• Stephanie Krenzelok, LCSW
• Olivia Kresmery
• Rhodes M Kriete, MD
• Loren Krizmanich
• Mathew Simon Kronman, P.T.
• Jessica Kroungold, MS
• Allan N Krutchik, MD

• General Practice Dentistry in Melbourne, FL
• Providers in Melbourne, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.