Provider Demographics
NPI:1700989993
Name:JETTON, GRETCHEN MAROUL (DDS)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:MAROUL
Last Name:JETTON
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:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:GUY
Mailing Address - State:TX
Mailing Address - Zip Code:77444
Mailing Address - Country:US
Mailing Address - Phone:713-858-0906
Mailing Address - Fax:
Practice Address - Street 1:2015 E BRAODWAY
Practice Address - Street 2:STE B
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581
Practice Address - Country:US
Practice Address - Phone:281-485-7012
Practice Address - Fax:281-485-3376
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics