Healthcare Provider Details

I. General information

NPI: 1750401907
Provider Name (Legal Business Name): SHELLEY ANN TRETTER DMD,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY TRETTER SUTTON

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11831 MASON MONTGOMERY RD SUITE A
CINCINNATI OH
45249-3706
US

IV. Provider business mailing address

2200 HEMPFLING RD
MORNING VIEW KY
41063-8764
US

V. Phone/Fax

Practice location:
  • Phone: 513-697-9999
  • Fax: 513-697-1045
Mailing address:
  • Phone: 859-363-7156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30019319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: