Provider Demographics
NPI:1942750559
Name:TSO PLLC
Entity Type:Organization
Organization Name:TSO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-441-2369
Mailing Address - Street 1:40 N GRAND AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4107
Mailing Address - Country:US
Mailing Address - Phone:859-441-2369
Mailing Address - Fax:859-442-3222
Practice Address - Street 1:40 N GRAND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4107
Practice Address - Country:US
Practice Address - Phone:859-441-2369
Practice Address - Fax:859-442-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41181223X0400X
KY87371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty