| Fortson Family Dentistry, P.c. | |
|
27347 Southfield Rd Lathrup Village MI 48076-3408 | |
| (248) 557-8120 | |
| Not Available |
| Full Name | Fortson Family Dentistry, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 27347 Southfield Rd, Lathrup Village, Michigan |
| Authorized Official Name and Position | Raymond Fortson (PRESIDENT) |
| Authorized Official Contact | 2485696722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fortson Family Dentistry, P.c. 17600 W 12 Mile Rd Suite 3 Southfield MI 48076-1910 Ph: () - | Fortson Family Dentistry, P.c. 27347 Southfield Rd Lathrup Village MI 48076-3408 Ph: (248) 557-8120 |
| NPI Number | 1215298468 |
|---|---|
| Provider Enumeration Date | 06/05/2012 |
| Last Update Date | 06/05/2012 |
| Medicare PECOS PAC ID | 1951844067 |
|---|---|
| Medicare Enrollment ID | O20240618000897 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215298468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2901014077 (Michigan) | Primary |
| Provider Name | James T Hiscock |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013973601 PECOS PAC ID: 9638163397 Enrollment ID: I20040414000584 |
| Provider Name | Cory Allen Fortson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1306258280 PECOS PAC ID: 1052683737 Enrollment ID: I20240607000301 |
| Provider Name | Catherine El Hadi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1245993336 PECOS PAC ID: 2264970615 Enrollment ID: I20240815003079 |
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