Provider Demographics
NPI:1447274089
Name:BRETZ, TERI (DMD)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:BRETZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 WOODDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2340
Mailing Address - Country:US
Mailing Address - Phone:952-920-9209
Mailing Address - Fax:
Practice Address - Street 1:3401 WOODDALE AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2340
Practice Address - Country:US
Practice Address - Phone:952-920-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist