NPIMap

Organization Active NPI

Forty Fort Dental LLC

  • General Practice Dentistry
  • Forty Fort, PA
National Provider Identifier
1922433937
Registry record updated Sep 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS035245 Issued in PA
Legal business name
FORTY FORT DENTAL LLC
Practice address
1590 Wyoming Ave
Forty Fort, PA 18704-4226
Phone
(570) 288-8170
NPI assigned
Sep 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2013

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

Authorized official

Name
Dr. Kelly S Williams, D.M.D.NPI 1134147903
Title
President
Phone
(570) 905-7638

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 DS035245 PA Primary

Addresses

Primary practice location

1590 Wyoming Ave
Forty Fort, PA 18704-4226

Mailing address

328 Bodle Rd
Wyoming, PA 18644-6016
Phone (570) 410-1035

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": "1378684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378684800000",
    "number": "1922433937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 BODLE RD",
            "city": "WYOMING",
            "state": "PA",
            "postal_code": "186446016",
            "telephone_number": "570-410-1035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1590 WYOMING AVE",
            "city": "FORTY FORT",
            "state": "PA",
            "postal_code": "187044226",
            "telephone_number": "570-288-8170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTY FORT DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-09",
        "last_updated": "2013-09-09",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-905-7638",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS035245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forty Fort, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2013; 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.