# RANDALL C. BRETZING

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528144052
- **Authorized official:** DR. RANDALL C. BRETZING DDS (PRESIDENT)
- **Authorized official phone:** (480) 329-5703

## Contact information

- **Practice address:** 2820 E UNIVERSITY DR, SUITE 108, MESA, AZ 85213-8500
- **Practice address phone:** (480) 830-0262
- **Practice address fax:** (480) 981-8355
- **Mailing address:** 1727 N CHESTNUT CIR, MESA, AZ 85213-3416
- **Mailing address phone:** (480) 329-5703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D2490 | AZ | Yes |

## Other

- **Enumeration date:** 10/27/2006
- **Last updated:** 01/27/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0473020 | BLUE CROSS BLUE SHIELD | — |
| 01 | — | 974453 | UNITED CONCORDIA | — |