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Organization

FORTY FORT DENTAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KELLY S WILLIAMS D.M.D. (PRESIDENT)
(570) 905-7638
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS035245
PA

Other

Enumeration date
09/09/2013
Last updated
09/09/2013
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