Organization
RANDALL C. BRETZING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL C. BRETZING DDS (PRESIDENT)
(480) 329-5703
Entity
Organization
Contact information
Practice address
2820 E UNIVERSITY DR, SUITE 108, MESA, AZ 85213-8500
(480) 830-0262
(480) 981-8355
Mailing address
1727 N CHESTNUT CIR, MESA, AZ 85213-3416
(480) 329-5703
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D2490
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0473020
BLUE CROSS BLUE SHIELD
—
01
—
974453
UNITED CONCORDIA
—
Enumeration date
10/27/2006
Last updated
01/27/2015
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