Active NPI
Harrison D Fortney, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Poway, CA
National Provider Identifier
1013094036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 23183
- Practice address
- 12630 Monte Vista Rd Ste 205
Poway, CA 92064-2527 - Phone
- (858) 485-1290
- Fax
- (858) 675-7485
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 23183 | CA | Primary |
Addresses
Primary practice location
12630 Monte Vista Rd Ste 205
Poway, CA 92064-2527
Mailing address
12630 Monte Vista Rd Ste 205
Poway, CA 92064-2527
Phone (858) 485-1290
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23183 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013094036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12630 MONTE VISTA RD STE 205",
"city": "POWAY",
"state": "CA",
"postal_code": "920642527",
"telephone_number": "858-485-1290",
"fax_number": "858-675-7485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12630 MONTE VISTA RD STE 205",
"city": "POWAY",
"state": "CA",
"postal_code": "920642527",
"telephone_number": "858-485-1290",
"fax_number": "858-675-7485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTNEY",
"first_name": "HARRISON",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CA",
"license": "23183",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poway, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.