Provider Demographics
NPI:1750401907
Name:TRETTER, SHELLEY ANN (DMD,MS)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:TRETTER
Suffix:
Gender:F
Credentials:DMD,MS
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:TRETTER
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 HEMPFLING RD
Mailing Address - Street 2:
Mailing Address - City:MORNING VIEW
Mailing Address - State:KY
Mailing Address - Zip Code:41063-8764
Mailing Address - Country:US
Mailing Address - Phone:859-363-7156
Mailing Address - Fax:
Practice Address - Street 1:11831 MASON MONTGOMERY RD
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-3706
Practice Address - Country:US
Practice Address - Phone:513-697-9999
Practice Address - Fax:513-697-1045
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300193191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics