Fortville Family Denistry LLC

NPI #1063657187 in Fortville, Indiana

Provider Information

NPI Number: 1063657187
Entity Type: Organization
Organization Name: Fortville Family Denistry LLC
Primary Specialty: Dentist
Enumeration Date: Dec 3, 2008
Last Updated: Dec 3, 2008

Practice Location

Address: 14 S MAIN ST
City: Fortville
State: Indiana
ZIP Code: 46040-1315
Phone: (317) 485-5251

Authorized Official

Name: DR. BRADLEY PAUL LACONI
Title: OWNER
Phone: (317) 485-5251

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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