Provider Demographics
NPI:1063725984
Name:DORROH, AUDRA SPURLIN (DMD)
Entity type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:SPURLIN
Last Name:DORROH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 HIGHWAY 44 E
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7178
Mailing Address - Country:US
Mailing Address - Phone:502-955-6460
Mailing Address - Fax:
Practice Address - Street 1:1250 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7178
Practice Address - Country:US
Practice Address - Phone:502-955-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY88971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice