| Fortson Dental, P.c. | |
|
27445 Southfield Rd Lathrup Village MI 48076-3411 | |
| (248) 352-1110 | |
| (248) 352-0801 |
| Full Name | Fortson Dental, P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 27445 Southfield Rd, Lathrup Village, Michigan |
| Authorized Official Name and Position | Raymond Fortson (PRESIDENT) |
| Authorized Official Contact | 2485696722 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fortson Dental, P.c. 27445 Southfield Road Lathrup Village MI 48076 Ph: () - | Fortson Dental, P.c. 27445 Southfield Rd Lathrup Village MI 48076-3411 Ph: (248) 352-1110 |
| NPI Number | 1992197172 |
|---|---|
| Provider Enumeration Date | 02/25/2015 |
| Last Update Date | 02/25/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992197172 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2901014077 (Michigan) | Primary |
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