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
—
—
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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