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Organization
MARKET ST DENTAL OFFICE PSC
Active
Organization
MARKET ST DENTAL OFFICE PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODNEY BRENT FULTZ DMD (SEC TREAS)
(502) 778-5141
Entity
Organization
Contact information
Practice address
2410 WEST MARKET ST, LOUISVILLE, KY 40212
(502) 778-5141
Mailing address
2410 WEST MARKET ST, LOUISVILLE, KY 40212
(502) 778-5141
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61942983
—
KY
Enumeration date
01/18/2007
Last updated
12/18/2007
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