Individual
DR. WILLIAM COLEMAN FORTENBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7731 OLD CANTON RD STE A, MADISON, MS 39110-6115
(601) 853-3565
(601) 853-3598
Mailing address
P. O. BOX 1547, MADISON, MS 39130
(601) 853-3565
(601) 853-3598
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2543
MS
1223G0001X
General Practice Dentistry
Primary
2543-90
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2543
DENTAL LICENSE
MS
Enumeration date
01/18/2007
Last updated
04/22/2021
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