Provider Demographics
NPI:1629035787
Name:RASSENFOSS, DEENA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEENA
Middle Name:A
Last Name:RASSENFOSS
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 1:5495 N BEND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-9378
Mailing Address - Country:US
Mailing Address - Phone:859-689-9225
Mailing Address - Fax:859-689-9201
Practice Address - Street 1:5495 N BEND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-9378
Practice Address - Country:US
Practice Address - Phone:859-689-9225
Practice Address - Fax:859-689-9201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY75241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice