IndividualActive
Cory Fortson
NPI 1306258280 · Oral and Maxillofacial Surgery (Dentist) · Southfield, MI
Provider details
- NPI number
- 1306258280
- Entity type
- Individual
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Sex
- Male
- Sole proprietor
- Yes
- License
- 2901021215 (MI)
Specialties & taxonomies
Dental Providers
Dental Providers
Practice location
17600 W 12 Mile Rd Ste 3
Southfield, MI 48076-1910
Phone: (248) 569-6722
Fax: (248) 569-7409
Approximate (ZIP-level) locationGet directions
Mailing address
17600 W 12 Mile Rd Ste 3
Southfield, MI 48076-1910
Registry dates
- Enumerated
- 2014-05-27
- Last updated
- 2024-05-08
- Certified
- 2024-05-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.