MEDICARE: GRETCHEN LYNNE KRATZ DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7711	KY

General Provider Information

NPI Number	:	1568682755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN LYNNE KRATZ DMD

Provider Business Mailing Address
First Line	:	3977 7TH STREET RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-4103
Country	:	US
Telephone Number	:	502-447-5699
Fax Number	:

Provider Business Practice Location Address
First Line	:	3977 7TH STREET RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-4103
Country	:	US
Telephone Number	:	502-447-5699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	09/21/2007

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