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General NPI Number Information
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NPI Number | 1801895115
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Entity Type | Organization
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Legal Business Name | KELLY W. FORD, D.M.D, MH. SPA
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 321 N LAUREL ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483
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Country | US
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Telephone | 843-871-6636
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Fax |
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Provider Business Mailing Address
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Address Line | 321 N LAUREL ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY W FORD
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Credential | DMD
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Telephone | 843-871-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3045
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 1790
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License Number State | SC
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