Individual
JAY NATHAN FORTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8209 GENOA AVENUE, SUITE 100, LUBBOCK, TX 79424
(806) 791-1481
(806) 791-1480
Mailing address
8209 GENOA AVENUE, SUITE 100, LUBBOCK, TX 79424
(806) 791-1481
(806) 791-1480
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
TX18583
TX
Other
Enumeration date
09/02/2006
Last updated
03/27/2013
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