Susan Cope Fortenberry, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

3429-07 Issued in MS

Practice address

5315 Highway 18 W
Jackson, MS 39209-9421

Phone

(601) 922-0066

Fax

(601) 922-0077

NPI assigned

Feb 17, 2010

Last updated

Feb 17, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Dentistry, P.a.

  • Pediatric Dentistry
  • Jackson, MS
  • NPI 1134414733
  NPD (past)

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266364800000",
    "number": "1083936132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5315 HIGHWAY 18 W",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392099421",
            "telephone_number": "601-922-0066",
            "fax_number": "601-922-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5315 HIGHWAY 18 W",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392099421",
            "telephone_number": "601-922-0066",
            "fax_number": "601-922-0077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "SUSAN",
        "middle_name": "COPE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-17",
        "last_updated": "2010-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": "3429-07",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Forsythe, N.P.
• Christian R Fortenberry, FNP
• Deborah Fortenberry, L.H.I.S
• Faith Fortenberry, DO
• Jackie Fortenberry, CRNA
• Anthony Lee Fortin, MD
• Audrey Lee Fortin, DMD
• John Dudley Foss, M.D.
• Charity Foster
• Danielle Christine Foster, RN, MD

• Pediatric Dentistry in Jackson, MS
• Providers in Jackson, MS by specialty
• Pediatric Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; 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.