Organization
COMMONWEALTH DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY BRYAN FORT DMD (SENIOR DENTIST)
(270) 782-1128
Entity
Organization
Contact information
Practice address
996 WILKINSON TACE, SUITE B6, BOWLING GREEN, KY 42103
(270) 782-1128
(270) 782-1117
Mailing address
996 WILKINSON TACE, SUITE B6, BOWLING GREEN, KY 42103
(270) 782-1128
(270) 782-1117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5683
KY
Other
Enumeration date
02/17/2007
Last updated
08/22/2020
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