NPIMap

Organization Active NPI

Commonwealth Dental

  • General Practice Dentistry
  • Bowling Green, KY
National Provider Identifier
1699819136
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5683 Issued in KY
Legal business name
COMMONWEALTH DENTAL
Practice address
996 Wilkinson Tace
Suite B6
Bowling Green, KY 42103
Phone
(270) 782-1128
Fax
(270) 782-1117
NPI assigned
Feb 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gregory Bryan Fort, DMDNPI 1548484553
Title
Senior Dentist
Phone
(270) 782-1128

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5683 KY Primary

Addresses

Primary practice location

996 Wilkinson Tace
Suite B6
Bowling Green, KY 42103

Mailing address

996 Wilkinson Tace
Suite B6
Bowling Green, KY 42103
Phone (270) 782-1128

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699819136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "996 WILKINSON TACE",
            "address_2": "SUITE B6",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42103",
            "telephone_number": "270-782-1128",
            "fax_number": "270-782-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "996 WILKINSON TACE",
            "address_2": "SUITE B6",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42103",
            "telephone_number": "270-782-1128",
            "fax_number": "270-782-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "BRYAN",
        "authorized_official_title_or_position": "SENIOR DENTIST",
        "authorized_official_telephone_number": "270-782-1128",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.