Broadway Dental Psc

LBN: Broadway Dental Psc
Broadway Dental Psc is an health care organization with primary practice located at 1813 West Broadway , Louisville KY 40203. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. Broadway Dental Psc can be contacted via phone (502) 772-7531, or through Fultz, Rodney Brent via phone (502) 772-7531.

Contact Information

Primary practice address
1813 West Broadway Louisville KY 40203
Phone: (502) 772-7531
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Fultz, Rodney Brent Doctor of Dental Medicine (DMD)
Phone: (502) 772-7531

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X

Profile Details

NPI number 1639222466
LBN Legal business name Broadway Dental Psc
DBA Doing business as
Authorized official Fultz, Rodney Brent Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 18th, 2007
Last updated Dec 18th, 2007 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639222466 NPPES
Kentucky MEDICAID 61941878

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