PORTLAND DENTAL PSC (NPI# 1528118601) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528118601 |
| Entity Type | Organization |
| Organization Name | PORTLAND DENTAL PSC |
| Practice Address |
465 North 26th Street Louisville KY 40212 |
| Practice Telephone | 5027787678 |
| Mailing Telephone | 5027787678 |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-12-18 |
| Authorized Official Name | DR. RODNEY BRENT FULTZ (SEC TREAS) |
| Authorized Official Telephone | 5027787678 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 61942447 | 05 |
| Street Address |
465 NORTH 26TH STREET |
| 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 |
| 1477605426 | Market St Dental Office Psc | Dentist | 2410 West Market St, Louisville, KY 40212 | 2007-01-18 |
| 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 | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114530748 | Sol Dental Pllc | Clinic/Center | 1371 Hecla Dr Ste D2, Louisville, CO 80027-2318 | 2020-08-24 |
| 1144838970 | Superior Smiles, LLC | Clinic/Center | 16690 E Main St, Louisville, MS 39339-2750 | 2020-07-17 |
| 1629696505 | Kauffmann and Sims Dentistry Pllc | Clinic/Center | 3935 Dupont Cir Ste A, Louisville, KY 40207-4824 | 2020-07-08 |
| 1699394783 | Professional Dental Services of Kentucky Psc | Clinic/Center | 4814 Outer Loop Ste A, Louisville, KY 40219-3302 | 2020-04-09 |
| 1316579279 | Shannon P Johnson Dmd Pllc | Clinic/Center | 9510 Ormsby Station Rd Ste 203, Louisville, KY 40223-4083 | 2020-02-09 |
| 1306306253 | Tds Ky Two | Clinic/Center | 5141 Dixie Hwy Ste 101, Louisville, KY 40216-1765 | 2019-03-25 |
| 1669937058 | Hometown Family Dental | Clinic/Center | 4122 Shelbyville Rd Ste C, Louisville, KY 40207-3212 | 2019-02-10 |
| 1447714944 | Cobalt Dental Care, LLC | Clinic/Center | 225 S Hurstbourne Pkwy Ste 102, Louisville, KY 40222-4929 | 2019-01-29 |
| 1285129882 | Combs Family Dentistry | Clinic/Center | 2300 Terra Crossing Blvd Ste 108, Louisville, KY 40245-5906 | 2018-06-26 |
| 1972097277 | D & D Dental Enterprises | Clinic/Center | 6790 Dixie Hwy, Louisville, KY 40258 | 2018-06-20 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40212 |
Please comment or provide details below to improve the information on PORTLAND DENTAL 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.