Fourth St Dental Center Psc

LBN: Fourth St Dental Center Psc
Fourth St Dental Center Psc is an health care organization with primary practice located at 1018 South Fourth Street , Louisville KY 40203. The organization recently has only one registered license in Ambulatory Health Care Facilities / Dental, which is considered as the primary health care specialty. Fourth St Dental Center Psc can be contacted via phone (502) 585-4320, or through Fultz, Rodney Brent via phone (502) 585-4320.

Contact Information

Primary practice address
1018 South Fourth Street Louisville KY 40203
Fax:
Website:
Authorized official contact:
Name: Fultz, Rodney Brent Doctor of Dental Medicine (DMD)

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Dental 261QD0000X

Profile Details

NPI number 1437205556
LBN Legal business name Fourth St Dental Center Psc
DBA Doing business as
Authorized official Fultz, Rodney Brent Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 25th, 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1437205556 NPPES
Kentucky MEDICAID 61943270

Popular Providers