Mason Cleary Ditthardt Fortuno, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN25001 Issued in FL

Practice address

1 Wahoo Ave
Groton, CT 06349-2324

Phone

(860) 694-2377

NPI assigned

May 15, 2020

Last updated

Sep 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1589500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1558983296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WAHOO AVE",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063492324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WAHOO AVE",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063492324",
            "telephone_number": "860-694-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTUNO",
        "first_name": "MASON",
        "middle_name": "CLEARY DITTHARDT",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-15",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN25001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mauricio Foronda, SUB IDC
• Fort Hill Counselors LLC
• Fort Hill Pharmacy Inc
• Fort Hill Pharmacy Inc
• Fort Hill Pharmacy, Inc. (Fort Hill Medical)
• Brian Charles Fournier
• Jessica Fretto, OD
• George Charles Fricke
• James Joseph Fritz, MD
• Alexandra Frobel, MFT

• General Practice Dentistry in Groton, CT
• Providers in Groton, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.