Provider Demographics
NPI:1437881539
Name:TASE TENRRERO, ADRIANA (DMD)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:TASE TENRRERO
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 1:3436 BRYAN WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1930
Mailing Address - Country:US
Mailing Address - Phone:502-807-1909
Mailing Address - Fax:
Practice Address - Street 1:100 VINELAND CENTRE DR
Practice Address - Street 2:
Practice Address - City:VINE GROVE
Practice Address - State:KY
Practice Address - Zip Code:40175-8430
Practice Address - Country:US
Practice Address - Phone:270-877-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY107961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice