Organization
RAYMOND A FORTSON JR & ASSOCIATES DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH FORTSON DDS (PRESIDENT)
(813) 468-4672
Entity
Organization
Contact information
Practice address
27445 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-3411
(248) 569-6722
Mailing address
27347 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-3408
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN10042
FL
Other
Enumeration date
10/21/2016
Last updated
10/21/2016
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