Individual
JACOB FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
635 ALBANY ST, BOSTON, MA 02118-3550
(601) 278-0923
Mailing address
15 BEAUVOIR PL, MADISON, MS 39110-8047
(601) 278-0923
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN10000426
MA
Other
Enumeration date
06/05/2024
Last updated
09/24/2024
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