| Market St Dental Office Psc | |
|
2410 West Market St Louisville KY 40212 | |
| (502) 778-5141 | |
| Not Available |
| Full Name | Market St Dental Office Psc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2410 West Market St, Louisville, Kentucky |
| Authorized Official Name and Position | Rodney Brent Fultz (SEC TREAS) |
| Authorized Official Contact | 5027785141 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Market St Dental Office Psc 2410 West Market St Louisville KY 40212 Ph: (502) 778-5141 | Market St Dental Office Psc 2410 West Market St Louisville KY 40212 Ph: (502) 778-5141 |
| NPI Number | 1477605426 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 12/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477605426 | NPI | - | NPPES |
| 61942983 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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