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

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 identifiers 1

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 and National Provider Directory roles.

• Madison Dental Group, PLLC

  • 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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "2543",
            "state": "MS"
        }
    ],
    "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
• Flowood River Oaks Hma Medical Group, LLC
• 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.