Organization
D.KEITH FORTSON,D.M.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS KEITH FORTSON D.M.D. (CEO)
(770) 775-4550
Entity
Organization
Contact information
Practice address
151 S HARKNESS ST, JACKSON, GA 30233-1832
(770) 775-4550
(770) 775-4338
Mailing address
151 S HARKNESS ST, JACKSON, GA 30233-1832
(770) 775-4550
(770) 775-4338
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN008764
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000136694A
—
GA
Enumeration date
02/25/2007
Last updated
05/29/2013
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