Organization
DIXIE DENTAL CENTER PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODNEY BRENT FULTZ DMD (SEC TREAS)
(502) 778-7414
Entity
Organization
Contact information
Practice address
1480 DIXIE HWY, LOUISVILLE, KY 40210
(502) 778-7414
Mailing address
1480 DIXIE HWY, LOUISVILLE, KY 40210
(502) 778-7414
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61942355
—
KY
Enumeration date
01/11/2007
Last updated
12/18/2007
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