# RAYMOND A FORTSON JR & ASSOCIATES DDS PC

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

## Provider details

- **NPI number:** 1831640135
- **Authorized official:** RALPH FORTSON DDS (PRESIDENT)
- **Authorized official phone:** (813) 468-4672

## Contact information

- **Practice address:** 27445 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-3411
- **Practice address phone:** (248) 569-6722
- **Mailing address:** 27347 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-3408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DN10042 | FL | Yes |

## Other

- **Enumeration date:** 10/21/2016
- **Last updated:** 10/21/2016