# COVINGTON DENTAL PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326198326
- **Authorized official:** DR. RODNEY BRENT FULTZ DMD (SEC TREAS)
- **Authorized official phone:** (859) 491-7453

## Contact information

- **Practice address:** 300 PIKE ST, COVINGTON, KY 41011
- **Practice address phone:** (859) 491-7453
- **Mailing address:** 300 PIKE ST, COVINGTON, KY 41011
- **Mailing address phone:** (859) 491-7453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 01/11/2007
- **Last updated:** 12/18/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 61942470 | — | KY |