Provider Demographics
NPI:1093935736
Name:GRETZULA, KRISTY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:GRETZULA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 HAWLEY LANE
Mailing Address - Street 2:UNIT 9
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614
Mailing Address - Country:US
Mailing Address - Phone:203-377-9300
Mailing Address - Fax:203-377-9301
Practice Address - Street 1:475 HAWLEY LANE
Practice Address - Street 2:UNIT 9
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614
Practice Address - Country:US
Practice Address - Phone:203-377-9300
Practice Address - Fax:203-377-9301
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist