Individual
DR. SUSAN COPE FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
5315 HIGHWAY 18 W, JACKSON, MS 39209-9421
(601) 922-0066
(601) 922-0077
Mailing address
5315 HIGHWAY 18 W, JACKSON, MS 39209-9421
(601) 922-0066
(601) 922-0077
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3429-07
MS
Other
Enumeration date
02/17/2010
Last updated
02/17/2010
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