Provider Demographics
NPI:1073852521
Name:FORTUNA, GIULIO (DMD, PHD)
Entity Type:Individual
Prefix:
First Name:GIULIO
Middle Name:
Last Name:FORTUNA
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 FLORIDA AVE
Mailing Address - Street 2:LOUISIANA STATE UNIVERSITY
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2715
Mailing Address - Country:US
Mailing Address - Phone:504-941-8330
Mailing Address - Fax:504-941-8336
Practice Address - Street 1:1100 FLORIDA AVE
Practice Address - Street 2:LOUISIANA STATE UNIVERSITY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2715
Practice Address - Country:US
Practice Address - Phone:504-941-8330
Practice Address - Fax:504-941-8336
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice