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Individual

DR. TYSON PERRERO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
2105 WEBER AVE, LOUISVILLE, KY 40205-2110
(502) 473-2011
(502) 473-2013
Mailing address
2105 WEBER AVE, LOUISVILLE, KY 40205-2110
(502) 473-2011
(502) 473-2013

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
9054
KY
1223G0001X
General Practice Dentistry
Primary
9054
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100178410
KY
Enumeration date
06/16/2009
Last updated
08/09/2012
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