Provider Demographics
NPI:1205868080
Name:DONALD R FORTNER JR DMD
Entity Type:Organization
Organization Name:DONALD R FORTNER JR DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:H
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-636-1848
Mailing Address - Street 1:1834 JAKE ALEXANDER BLVD. WEST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147
Mailing Address - Country:US
Mailing Address - Phone:704-636-1848
Mailing Address - Fax:704-636-4890
Practice Address - Street 1:1834 JAKE ALEXANDER BLVD. WEST
Practice Address - Street 2:SUITE 504
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147
Practice Address - Country:US
Practice Address - Phone:704-636-1848
Practice Address - Fax:704-636-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty