Rodney Brent Fultz, DMD DENTIST

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5242 Issued in KY

Practice address

1813 West Broadway
Louisville, KY 40203-0000

Phone

(502) 772-7531

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Broadway Dental PSC

  • Dentist
  • Louisville, KY
  • NPI 1639222466
  NPD (past) Authorized official
• Family Dental Care Associates PSC

  • Dental Clinic/Center
  • Florence, KY
  • NPI 1962554626
  NPD (past) Authorized official

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328745600000",
    "number": "1962559328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6616 DIXIE HWY #1",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410422166",
            "telephone_number": "859-371-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 WEST BROADWAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402030000",
            "telephone_number": "502-772-7531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTZ",
        "first_name": "RODNEY",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "DMD DENTIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2012-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005242000",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Weldon Fuller
• Zachary Allen Fuller
• Zachariah Ronald Fulmore, DMD
• Carmen Rosella Fulton-Fox, ASSOCIATE
• Mallory Fulton
• Sharon Lee Fultz
• Raphael Fumey, PHD
• Functional Imaging and Assessment of Kentucky PSC
• Functional Therapy, PLLC
• Kelli Carpenter Funk, PHARM.D.

• General Practice Dentistry in Louisville, KY
• Providers in Louisville, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; 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.