Jacob Fortenberry, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

32429 Issued in FL

Practice address

17661 Harpers Run
Lutz, FL 33558-5737

Phone

(601) 278-0923

NPI assigned

Jun 5, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786320000000",
    "number": "1003657651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 S FREMONT AVE APT 1127",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062015",
            "telephone_number": "601-278-0923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17661 HARPERS RUN",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335585737",
            "telephone_number": "601-278-0923"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7731 Old Canton Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "391106115",
            "country_code": "US",
            "telephone_number": "601-278-0923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "JACOB",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-05",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "4466-24",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "32429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Joseph Foley, D.M.D.
• Les R Folio, DO
• Stanley Dingbobga Fomban, APRN
• Shelly Fonseca
• Donna Ford, LMHC
• Maliah Ariel Fortes
• Tyler Fortwangler
• Steven Mark Fountain, ARNP
• Fourth Trimester Wellness LLC
• Emily Marie Fowler, MS, CCC-SLP

• Endodontics in Lutz, FL
• Providers in Lutz, FL by specialty
• Endodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.