Individual
DR. CORY FORTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17600 W 12 MILE RD STE 3, SOUTHFIELD, MI 48076-1910
(248) 569-6722
(248) 569-7409
Mailing address
17600 W 12 MILE RD STE 3, SOUTHFIELD, MI 48076-1910
(248) 569-6722
(248) 569-7409
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901021215
MI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901021215
MI
Other
Enumeration date
05/27/2014
Last updated
05/08/2024
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