Provider Demographics
NPI:1992472344
Name:HARRIS, GRETCHEN LOUISE (DMD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:LOUISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:GRETCHEN
Other - Middle Name:LOUISE
Other - Last Name:KISTENMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61516 ALSTRUP RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9718
Mailing Address - Country:US
Mailing Address - Phone:712-221-0769
Mailing Address - Fax:
Practice Address - Street 1:3211 N HWY 97 STE 120
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7571
Practice Address - Country:US
Practice Address - Phone:541-640-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD114771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice