Portland Dental Psc

LBN: Portland Dental Psc
Portland Dental Psc is an health care organization with primary practice located at 465 North 26Th Street , Louisville KY 40212. The organization recently has only one registered license in Ambulatory Health Care Facilities / Dental, which is considered as the primary health care specialty. Portland Dental Psc can be contacted via phone (502) 778-7678, or through Fultz, Rodney Brent via phone (502) 778-7678.

Contact Information

Primary practice address
465 North 26Th Street Louisville KY 40212
Phone: (502) 778-7678
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Fultz, Rodney Brent Doctor of Dental Medicine (DMD)
Phone: (502) 778-7678

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Dental 261QD0000X

Profile Details

NPI number 1528118601
LBN Legal business name Portland 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 11th, 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 1528118601 NPPES
Kentucky MEDICAID 61942447

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