Gretchen Louise Harris, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11477 Issued in OR

Practice address

3211 N Hwy 97 Ste 120
Bend, OR 97703-7571

Phone

(541) 640-4584

NPI assigned

Aug 24, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Gretchen Louise Kistenmacher Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grant Park Dentistry, PC

  • General Practice Dentistry
  • Portland, OR
  • NPI 1205220209
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1992472344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61516 ALSTRUP RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977029718",
            "telephone_number": "712-221-0769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3211 N HWY 97 STE 120",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037571",
            "telephone_number": "541-640-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "GRETCHEN",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-24",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRETCHEN",
            "last_name": "KISTENMACHER",
            "middle_name": "LOUISE",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Allan Alexander Harris, N.D., L.AC.
• Andrea Harris
• Bryan D. Harris, M.D.
• Dianna Harris, PSYD, PMHNP
• Frank Ronald Harris II, CADC-R
• Holly McCown Harris, LPC
• Jay Edward Harris, RN, MSN
• Jenifer Harris
• Joshua James Harris
• Keith Harris, PHD

• General Practice Dentistry in Bend, OR
• Providers in Bend, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.