Healthcare Provider Details

I. General information

NPI: 1427931237
Provider Name (Legal Business Name): JOSEPH SEAN FORTKORT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 S FIFTH ST STE D
MEBANE NC
27302-9756
US

IV. Provider business mailing address

1242 S FIFTH ST STE D
MEBANE NC
27302-9756
US

V. Phone/Fax

Practice location:
  • Phone: 919-304-1666
  • Fax: 919-304-1698
Mailing address:
  • Phone: 919-304-1666
  • Fax: 919-304-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: