Organization
C R FORT DMD PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ROBERT FORT DMD (OWNER)
(863) 285-7121
Entity
Organization
Contact information
Practice address
330 E BROADWAY ST, FORT MEADE, FL 33841-3012
(863) 285-7121
(863) 285-8648
Mailing address
330 E BROADWAY ST, FORT MEADE, FL 33841-3012
(863) 285-7121
(863) 285-8648
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8002
FL
Other
Enumeration date
11/07/2012
Last updated
11/07/2012
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