Organization
FORTSON FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND FORTSON JR. DDS (PRESIDENT)
(248) 569-6722
Entity
Organization
Contact information
Practice address
27347 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-3408
(248) 557-8120
Mailing address
17600 W 12 MILE RD, SUITE 3, SOUTHFIELD, MI 48076-1910
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901014077
MI
Other
Enumeration date
06/05/2012
Last updated
06/05/2012
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