MARKET ST DENTAL OFFICE PSC (NPI# 1477605426) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477605426 |
| Entity Type | Organization |
| Organization Name | MARKET ST DENTAL OFFICE PSC |
| Practice Address |
2410 West Market St Louisville KY 40212 |
| Practice Telephone | 5027785141 |
| Mailing Telephone | 5027785141 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-12-18 |
| Authorized Official Name | DR. RODNEY BRENT FULTZ (SEC TREAS) |
| Authorized Official Telephone | 5027785141 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 61942983 | 05 |
| Street Address |
2410 WEST MARKET ST |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003433111 | Shanita Flanagan | Home Health Aide | 4519 Southwestern Parkway, Louisville, KY 40212 | 2020-07-06 |
| 1184118887 | Denise Goldsmith-kelley | Licensed Practical Nurse | 2611 Northwestern Pkwy, Louisville, KY 40212 | 2018-06-18 |
| 1528118601 | Portland Dental Psc | Clinic/Center | 465 North 26th Street, Louisville, KY 40212 | 2007-01-11 |
| 1790393643 | Quality Home Care Services, LLC | In Home Supportive Care | 4519 Southwestern Parkway, Same, Louisville, KY 40212 | 2020-07-16 |
| 1659884872 | New Leaf Clinic | Clinic/Center | 2910 W Jefferson St, Louisville, KY 40212 | 2017-11-09 |
| 1043670391 | Rod Ali Erfani | Dentist | 2215 Portland Ave, Louisville, KY 40212 | 2016-02-29 |
| 1164754008 | Deborah J Moreau | Nurse Practitioner | 234 Amy Ave, Louisville, KY 40212 | 2010-02-03 |
| 1386778710 | Patricia Link Fulkerson | Social Worker | 2215 Portland Ave, Louisville, KY 40212 | 2007-03-15 |
| 1982617387 | Julie R Aull | Physician Assistant | 234 Amy Ave, Louisville, KY 40212 | 2006-08-15 |
| 1033115878 | Carla Marie Broderick | Nurse Practitioner | 2215 Portland Ave, Louisville, KY 40212 | 2005-06-27 |
| Find all providers in zip 40212 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235781485 | Rylie Mike-mayer | Dentist | 302 Axis Dr Apt 401, Louisville, KY 40206-0139 | 2019-07-09 |
| 1922580653 | Advanced Dental Center, Inc. | Dentist | 1901 Rudy Ln Ste 4, Louisville, KY 40207-1384 | 2018-08-29 |
| 1043701451 | Diana H Tran | Dentist | 501 S Preston St Rm 148, Louisville, KY 40202-1701 | 2018-05-21 |
| 1992295653 | Tyler Benton Blount | Dentist | 8013 New La Grange Rd Ste 6, Louisville, KY 40222-4700 | 2018-05-17 |
| 1407346901 | Louisville Dental Associates LLC | Dentist | 16701 E Main St, Louisville, MS 39339-2751 | 2018-05-10 |
| 1194238816 | Dental Services of Kentucky, Psc | Dentist | 2011 Grinstead Dr Unit 102, Louisville, KY 40204-1296 | 2017-11-16 |
| 1366963373 | Caleb William Reece | Dentist | 2201 Biljana Dr Apt 1, Louisville, KY 40206-2175 | 2017-06-29 |
| 1205366846 | Triple Crown Dentistry | Dentist | 904 Lily Creek Road, Suite 101, Louisville, KY 40243 | 2017-06-15 |
| 1740733559 | Jonathan Mitchell, Dmd, Psc | Dentist | 1716 Gardiner Ln, Louisville, KY 40205-2738 | 2016-07-27 |
| 1215389168 | Charles Kendrick Bunch | Dentist | 1030 Mulberry St, Louisville, KY 40217-1253 | 2016-07-04 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40212 |
Please comment or provide details below to improve the information on MARKET ST DENTAL OFFICE PSC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.