Provider Demographics
NPI:1609484245
Name:KREKLOW, GRETCHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:
Last Name:KREKLOW
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 1:510 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2627
Mailing Address - Country:US
Mailing Address - Phone:218-326-1266
Mailing Address - Fax:
Practice Address - Street 1:510 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2627
Practice Address - Country:US
Practice Address - Phone:218-326-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist