Organization
COVINGTON DENTAL PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODNEY BRENT FULTZ DMD (SEC TREAS)
(859) 491-7453
Entity
Organization
Contact information
Practice address
300 PIKE ST, COVINGTON, KY 41011
(859) 491-7453
Mailing address
300 PIKE ST, COVINGTON, KY 41011
(859) 491-7453
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61942470
—
KY
Enumeration date
01/11/2007
Last updated
12/18/2007
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