# COMMONWEALTH DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699819136
- **Authorized official:** DR. GREGORY BRYAN FORT DMD (SENIOR DENTIST)
- **Authorized official phone:** (270) 782-1128

## Contact information

- **Practice address:** 996 WILKINSON TACE, SUITE B6, BOWLING GREEN, KY 42103
- **Practice address phone:** (270) 782-1128
- **Practice address fax:** (270) 782-1117
- **Mailing address:** 996 WILKINSON TACE, SUITE B6, BOWLING GREEN, KY 42103
- **Mailing address phone:** (270) 782-1128
- **Mailing address fax:** (270) 782-1117

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5683 | KY | Yes |

## Other

- **Enumeration date:** 02/17/2007
- **Last updated:** 08/22/2020