MEDICARE: DIXIE DENTAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679986160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIXIE DENTAL CENTER

Provider Business Mailing Address
First Line	:	1480 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1768
Country	:	US
Telephone Number	:	502-778-7414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1768
Country	:	US
Telephone Number	:	502-778-7414
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ROD FULTZ
Credential	:	DMD
Telephone Number	:	502-778-7414

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	06/03/2014

Similar Medicare Providers

1649260464 — DR. DAVID NEAL WAUGH DMD
Practice Location Address:

1480 DIXIE HWY
LOUISVILLE, KY
40210-1768

Practice Phone: 502-778-7414
Practice Fax:

1639759392 — DIXIE DENTAL AND DENTURES LLC
Practice Location Address:

1480 DIXIE HWY
LOUISVILLE, KY
40210-1768

Practice Phone: 502-778-7414
Practice Fax:

1376698670 — JAMES L SCHORCH LCSW
Practice Location Address:

1167 E BROADWAY
LOUISVILLE, KY
40204-1768

Practice Phone: 502-821-6309
Practice Fax:

1730653767 — J L SCHORCH LCSW PSC
Practice Location Address:

1167 E BROADWAY STE 400
LOUISVILLE, KY
40204-1768

Practice Phone: 502-821-6309
Practice Fax:

1073452926 — DECORIYANNA GARRETT
Practice Location Address:

1038 S 17TH ST
LOUISVILLE, KY
40210-2459

Practice Phone: 502-953-3399
Practice Fax:

1588503361 — JASMINE R FURMON
Practice Location Address:

708 S 16TH ST
LOUISVILLE, KY
40210-1016

Practice Phone: 502-905-2300
Practice Fax:

Directions to “DIXIE DENTAL CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.