Provider Demographics
NPI:1366488934
Name:FORTNEY, HOMER RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOMER
Middle Name:RICHARD
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MYERS STREET
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:KY
Mailing Address - Zip Code:40823-0426
Mailing Address - Country:US
Mailing Address - Phone:606-589-2900
Mailing Address - Fax:
Practice Address - Street 1:110 MYERS STREET
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:KY
Practice Address - Zip Code:40823-0426
Practice Address - Country:US
Practice Address - Phone:606-589-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist