Healthcare Provider Details

I. General information

NPI: 1750216297
Provider Name (Legal Business Name): GRETCHEN MARIE BRUMMOND DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PARK ST E
PARK RIVER ND
58270-4428
US

IV. Provider business mailing address

PO BOX 592
PARK RIVER ND
58270-0592
US

V. Phone/Fax

Practice location:
  • Phone: 701-284-6131
  • Fax:
Mailing address:
  • Phone: 701-331-2825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2593
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: