Individual
DR. GLENN W FORTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3950 SPRINGFIELD RD, GLEN ALLEN, VA 23060-4119
(804) 346-4600
(804) 346-9503
Mailing address
3950 SPRINGFIELD RD, GLEN ALLEN, VA 23060-4119
(804) 346-4600
(804) 346-9503
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007404
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401007404
LICENSE
VA
01
—
094412
ANTHEM ID
VA
01
—
867855
UNITED CONCORDIA
VA
Enumeration date
10/24/2006
Last updated
07/08/2007
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