Healthcare Provider Details

I. General information

NPI: 1619941887
Provider Name (Legal Business Name): GARY W. FORT D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD
ASHEVILLE NC
28805-2576
US

IV. Provider business mailing address

1100 TUNNEL RD
ASHEVILLE NC
28805-2576
US

V. Phone/Fax

Practice location:
  • Phone: 828-297-7911
  • Fax:
Mailing address:
  • Phone: 828-297-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5251
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: