| NPI | 1417009200 |
|---|---|
| Professional Name | COLE FORTENBERRY |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2543-90) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 2543) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2021-04-22 |