Organization
DIXIE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROD FULTZ DMD (DENTIST)
(502) 778-7414
Entity
Organization
Contact information
Practice address
1480 DIXIE HWY, LOUISVILLE, KY 40210-1768
(502) 778-7414
Mailing address
1480 DIXIE HWY, LOUISVILLE, KY 40210-1768
(502) 778-7414
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61942355
—
KY
Enumeration date
06/03/2014
Last updated
06/03/2014
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