# FORTY FORT DENTAL LLC

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

## Provider details

- **NPI number:** 1922433937
- **Authorized official:** DR. KELLY S WILLIAMS D.M.D. (PRESIDENT)
- **Authorized official phone:** (570) 905-7638

## Contact information

- **Practice address:** 1590 WYOMING AVE, FORTY FORT, PA 18704-4226
- **Practice address phone:** (570) 288-8170
- **Mailing address:** 328 BODLE RD, WYOMING, PA 18644-6016
- **Mailing address phone:** (570) 410-1035

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS035245 | PA | Yes |

## Other

- **Enumeration date:** 09/09/2013
- **Last updated:** 09/09/2013