Charles Mark Fort, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5602 Issued in KY

Practice address

1208 E Byers Ave
Owensboro, KY 42303-7558

Phone

(270) 926-3838

Fax

(270) 926-0452

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144234725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 E BYERS AVE",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423037558",
            "telephone_number": "270-926-3838",
            "fax_number": "270-926-0452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 E BYERS AVE",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423037558",
            "telephone_number": "270-926-3838",
            "fax_number": "270-926-0452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORT",
        "first_name": "CHARLES",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60056025",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Ford, CST,CFA
• Tara Ford
• Lauren Foreman, R.D.
• Yvonne L. Forest, LMT
• Nicole Foright, OTR/L
• Tara Fortener
• Christopher Chad Foster, LCSW
• James Foster, LMT, MMP, BCTMB
• James M Foster, CRNA
• Jessica Foster

• General Practice Dentistry in Owensboro, KY
• Providers in Owensboro, KY by specialty
• General Practice Dentistry in Kentucky

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.