Provider Demographics
NPI:1003276965
Name:TRITLE FAMILY DENTISTRY, PSC
Entity type:Organization
Organization Name:TRITLE FAMILY DENTISTRY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:BEYERLE
Authorized Official - Last Name:TRITLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-299-2888
Mailing Address - Street 1:2418 NEW HOLT RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7455
Mailing Address - Country:US
Mailing Address - Phone:270-554-4445
Mailing Address - Fax:270-554-4248
Practice Address - Street 1:2418 NEW HOLT RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7455
Practice Address - Country:US
Practice Address - Phone:270-554-4445
Practice Address - Fax:270-554-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental