# DIXIE DENTAL CENTER

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

## Provider details

- **NPI number:** 1679986160
- **Authorized official:** DR. ROD FULTZ DMD (DENTIST)
- **Authorized official phone:** (502) 778-7414

## Contact information

- **Practice address:** 1480 DIXIE HWY, LOUISVILLE, KY 40210-1768
- **Practice address phone:** (502) 778-7414
- **Mailing address:** 1480 DIXIE HWY, LOUISVILLE, KY 40210-1768
- **Mailing address phone:** (502) 778-7414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 06/03/2014
- **Last updated:** 06/03/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 61942355 | — | KY |