1558066118 NPI number — DR. JORDAN WILLIAM TRETBAR DDS

Table of content: DR. JORDAN WILLIAM TRETBAR DDS (NPI 1558066118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558066118 NPI number — DR. JORDAN WILLIAM TRETBAR DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRETBAR
Provider First Name:
JORDAN
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558066118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13TH ADC, 1ST DENTAL BATTALION/NAVAL DENTAL CENTER
Provider Second Line Business Mailing Address:
CAMP PENDLETON BLDG. 13128 14TH STREET
Provider Business Mailing Address City Name:
CAMP PENDLETON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92055-5221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-681-6944
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13TH ADC, 1ST DENTAL BATTALION/NAVAL DENTAL CENTER
Provider Second Line Business Practice Location Address:
CAMP PENDLETON BLDG. 13128 14TH STREET
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-681-6944
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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