Portland Dental PSC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PORTLAND DENTAL PSC

Practice address

465 North 26TH Street
Louisville, KY 40212

Phone

(502) 778-7678

NPI assigned

Jan 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Rodney Brent Fultz, DMD

Title

Sec Treas

Phone

(502) 778-7678

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1528118601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 NORTH 26TH STREET",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40212",
            "telephone_number": "502-778-7678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 NORTH 26TH STREET",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40212",
            "telephone_number": "502-778-7678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND DENTAL PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "FULTZ",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "SEC TREAS",
        "authorized_official_telephone_number": "502-778-7678",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61942447",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalie Porter, LPAT
• Paula J Porter, LCSW
• Scott Porter
• Thomas Alan Porter, DMD
• Vincent Allen Porter, M.D.
• Maleena Portman
• Jonathan Portuondo-Suarez
• Krista Portwood, PHARMD
• Alexis Posey
• Dionta Posey, APRN

• Dental Clinic/Center in Louisville, KY
• Providers in Louisville, KY by specialty
• Dental Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.