Provider Demographics
NPI:1013094036
Name:FORTNEY, HARRISON D (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:D
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12630 MONTE VISTA RD STE 205
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2527
Mailing Address - Country:US
Mailing Address - Phone:858-485-1290
Mailing Address - Fax:858-675-7485
Practice Address - Street 1:12630 MONTE VISTA RD STE 205
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2527
Practice Address - Country:US
Practice Address - Phone:858-485-1290
Practice Address - Fax:858-675-7485
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery