Organization
SOUTHFIELD DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND A FORTSON JR. DDS (MEMBER)
(248) 569-6722
Entity
Organization
Contact information
Practice address
17600 W 12 MILE RD, SUITE 3, SOUTHFIELD, MI 48076-1910
(248) 569-6722
(248) 569-7409
Mailing address
17600 W 12 MILE RD, SUITE 3, SOUTHFIELD, MI 48076-1910
(248) 569-6722
(248) 569-7409
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901014077
MI
Other
Enumeration date
03/12/2009
Last updated
03/12/2009
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