Provider Demographics
NPI:1376037341
Name:CHILDRESS, ADRIENNE LASHAE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:LASHAE
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1658
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-1658
Mailing Address - Country:US
Mailing Address - Phone:606-308-5045
Mailing Address - Fax:
Practice Address - Street 1:4095 ATWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8325
Practice Address - Country:US
Practice Address - Phone:859-623-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice