Search › Michigan › 1223S0112X
Cory Fortson
NPI 1306258280 · on the registry since 2014 · sole proprietor
Practice
- Address
- 17600 W 12 Mile Rd Ste 3
Southfield, MI 48076 - Phone
- (248) 569-6722
- Fax
- (248) 569-7409
- Organisation at this address
- Eagan Orthodontics Pc
Southfield Dental PllcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 4
Registry record
- Primary taxonomy
- 1223S0112X
1223S0112X
- Also registered as
- 122300000X
- Licence states on file
- MI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2024-05-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan