Individual
SYBIL ANN FORTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
504 NW 10TH AVE, AVA, MO 65608
(417) 683-4831
(417) 683-1602
Mailing address
PO BOX 1359, AVA, MO 65608-1359
(417) 683-4831
(417) 683-1602
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2007014535
MO
Other
Enumeration date
06/06/2007
Last updated
03/06/2008
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