Healthcare Provider Details

I. General information

NPI: 1902990401
Provider Name (Legal Business Name): RICHARD A. ADRIO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BRECKENRIDGE LANE
LOUISVILLE KY
40207
US

IV. Provider business mailing address

209 BRECKENRIDGE LANE
LOUISVILLE KY
40207
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-0474
  • Fax: 502-895-2223
Mailing address:
  • Phone: 502-895-0474
  • Fax: 502-895-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5561
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number567
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number568
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: