# FORTSON DENTAL OAK PARK P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336610633
- **Authorized official:** JAMIE SOLI (OFFICE MANAGER)
- **Authorized official phone:** (248) 398-5400

## Contact information

- **Practice address:** 13741 W 11 MILE RD, OAK PARK, MI 48237-6926
- **Practice address phone:** (248) 398-5400
- **Practice address fax:** (248) 398-4752
- **Mailing address:** 13741 W 11 MILE RD, OAK PARK, MI 48237-6926

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/12/2018
- **Last updated:** 12/12/2018