1750401907 NPI number — SHELLEY ANN TRETTER DMD,MS

Table of content: SAMUEL G DOZIER MD (NPI 1043283039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750401907 NPI number — SHELLEY ANN TRETTER DMD,MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRETTER
Provider First Name:
SHELLEY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD,MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUTTON
Provider Other First Name:
SHELLEY
Provider Other Middle Name:
TRETTER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750401907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 HEMPFLING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORNING VIEW
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41063-8764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-363-7156
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11831 MASON MONTGOMERY RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45249-3706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-697-9999
Provider Business Practice Location Address Fax Number:
513-697-1045
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  30019319 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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