Fortenberry, William Coleman

Fortenberry, William Coleman is an sole proprietor health care provider with primary practice located at 7731 Old Canton Rd Ste A , Madison MS 39110-6115. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is his primary health care specialty. Fortenberry, William Coleman can be contacted via phone (601) 853-3565.

Contact Information

Primary practice address
7731 Old Canton Rd Ste A Madison MS 39110-6115
Phone: (601) 853-3565
Fax: (601) 853-3598
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 2543 Mississippi
Dental Providers / General Practice 1223G0001X 2543-90 Mississippi

Profile Details

NPI number 1417009200
LBN Legal business name Fortenberry, William Coleman
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 18th, 2007
Last updated Apr 22nd, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417009200 NPPES
Mississippi Other 2543 DENTAL LICENSE

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