Provider Demographics
NPI:1295942597
Name:FORTINO, LINDA (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:FORTINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32931 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 608
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1772
Mailing Address - Country:US
Mailing Address - Phone:248-626-0772
Mailing Address - Fax:248-626-3572
Practice Address - Street 1:32931 MIDDLEBELT RD
Practice Address - Street 2:SUITE 608
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1772
Practice Address - Country:US
Practice Address - Phone:248-626-0772
Practice Address - Fax:248-626-3572
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI11557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist