Provider Demographics
NPI:1487675906
Name:CASTLEMAN, GRETCHEN GIBSON (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:GIBSON
Last Name:CASTLEMAN
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:DR
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3425 N BELLSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6143
Mailing Address - Country:US
Mailing Address - Phone:479-445-8636
Mailing Address - Fax:
Practice Address - Street 1:2901 SAINT JOHNS BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1598
Practice Address - Country:US
Practice Address - Phone:417-208-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230047571223G0001X
AR2927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist