Individual
MISTY GAIL GRETENCORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
4315 COMMERCE DR STE 310, LAFAYETTE, IN 47905-3824
(765) 588-0220
Mailing address
1300 HASP WAY, LAFAYETTE, IN 47905-8520
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011005A
IN
122300000X
Dentist
25549
TX
1223G0001X
General Practice Dentistry
Primary
12011005A
IN
Other
Enumeration date
08/28/2007
Last updated
03/30/2026
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