Cory Fortson

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901021215 Issued in MI

Practice address

17600 W 12 Mile Rd Ste 3
Southfield, MI 48076-1910

Phone

(248) 569-6722

Fax

(248) 569-7409

NPI assigned

May 27, 2014

Sex

Male

Sole proprietor

Yes

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

Enrolled in MI

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

Practice roles

Locations

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

• Fortson Dentistry Milford P.C.

  • Dentist
  • Highland, MI
  • NPI 1184394249
  Medicare reassignment NPD
• Fortson Family Dentistry, P.C.

  • General Practice Dentistry
  • Lathrup Village, MI
  • NPI 1215298468
  Medicare reassignment NPD
• Raymond a Fortson Jr & Associates DDS PC

  • Dentist
  • Lathrup Village, MI
  • NPI 1831640135
  NPD (past)
• Southfield Dental PLLC

  • Dentist
  • Southfield, MI
  • NPI 1104067644
  NPD (past)

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

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1306258280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17600 W 12 MILE RD STE 3",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480761910",
            "telephone_number": "248-569-6722",
            "fax_number": "248-569-7409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17600 W 12 MILE RD STE 3",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480761910",
            "telephone_number": "248-569-6722",
            "fax_number": "248-569-7409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTSON",
        "first_name": "CORY",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-27",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021215",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901021215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam M Forman, MD
• Lisa L Forrester, RN
• Linda K Forsberg, PH.D.
• Barbara Forte, RPH
• Sarah E Fortier, BCBA
• Forward Perspective Counseling, LLC
• Amy Foster
• Ann Michelle Foster, LICENSED PRACTICAL N
• Briana Joanne Foster, MA, TLLP
• Cynthia Foster, D.D.S.

• Oral and Maxillofacial Surgery (Dentist) in Southfield, MI
• Providers in Southfield, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.