William Coleman Fortenberry, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2543-90 Issued in MS

Practice address

7731 Old Canton Rd Ste a
Madison, MS 39110-6115

Phone

(601) 853-3565

Fax

(601) 853-3598

NPI assigned

Jan 18, 2007

Last updated

Apr 22, 2021By the provider in NPPES

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

Other names 1

• Dr. Cole Fortenberry Professional name

Electronic endpoints 1

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.

• Madison Dental Group, PLLC

  dba Madison Dental Group

  • Dental Clinic/Center
  • Madison, MS
  • NPI 1760106199
  NPD (past) Authorized official

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1417009200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 1547",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39130",
            "telephone_number": "601-853-3565",
            "fax_number": "601-853-3598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7731 OLD CANTON RD STE A",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106115",
            "telephone_number": "601-853-3565",
            "fax_number": "601-853-3598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "WILLIAM",
        "middle_name": "COLEMAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MS",
            "license": "2543",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2543-90",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "officemanager@madisondentalgroup.org",
            "affiliation": "N",
            "address_1": "7731 Old Canton Rd Ste A",
            "city": "Madison",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391106115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "COLE",
            "last_name": "FORTENBERRY",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Karen Fitzgerald, RD
• Brittany Thomas Flaggs, DPT
• Flowood River Oaks Hma Medical Group, LLC (Care Plus Germantown Family Medicine)
• Flowood River Oaks Hma Medical Group, LLC (CarePlus Madison Family Medicine)
• Chancey Fort, LPC, RPT, NCC, NCSC
• Brandon Sloane Fortinberry, D.C.
• Mary Rebecca Foster, CCC-A
• Fountains Infusion Center LLC
• Tyler Fuller, PHARMD
• John Christopher Funkhouser, N.P.

• General Practice Dentistry in Madison, MS
• Providers in Madison, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; 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.