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Organization
NORTH TAMPA DENTAL, P.A.
Active
Organization
NORTH TAMPA DENTAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RALPH W FORTSON DDS (PRESIDENT)
(813) 968-1170
Entity
Organization
Contact information
Practice address
10549 N FLORIDA AVE, SUITE E, TAMPA, FL 33612-6707
(813) 935-3129
Mailing address
14115 RIVERSTONE DR, TAMPA, FL 33624-6932
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN10042
FL
Other
Enumeration date
05/28/2015
Last updated
05/28/2015
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