Fortson Dental, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901014077 Issued in MI

Legal business name

FORTSON DENTAL, P.C.

Practice address

27445 Southfield Rd
Lathrup Village, MI 48076-3411

Phone

(248) 352-1110

Fax

(248) 352-0801

NPI assigned

Feb 25, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Raymond Fortson Jr., DDS

Title

President

Phone

(248) 569-6722

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1424822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424822400000",
    "number": "1992197172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27445 SOUTHFIELD ROAD",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "48076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27445 SOUTHFIELD RD",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480763411",
            "telephone_number": "248-352-1110",
            "fax_number": "248-352-0801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTSON DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-25",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "FORTSON",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-569-6722",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901014077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Lathrup Village, MI
• Providers in Lathrup Village, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; 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.