Provider Demographics
NPI:1164506911
Name:BRETL, HERBERT N (DDS)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:N
Last Name:BRETL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 SHOREY AVE
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5648
Mailing Address - Country:US
Mailing Address - Phone:715-355-7077
Mailing Address - Fax:715-842-4369
Practice Address - Street 1:223 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:EDGAR
Practice Address - State:WI
Practice Address - Zip Code:54426-9281
Practice Address - Country:US
Practice Address - Phone:715-352-2700
Practice Address - Fax:715-842-4369
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5378-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice