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General NPI Number Information
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NPI Number | 1013428374
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Entity Type | Organization
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Legal Business Name | GLENN W. FORTNER DDS, PC
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Dates
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Enumeration Date | 10/13/2017
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Last Update Date | 10/13/2017
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Provider Practice Location Address
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Address Line | 3950 SPRINGFIELD RD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-4119
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Country | US
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Telephone | 804-346-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 3950 SPRINGFIELD RD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-4119
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | GLENN FORTNER
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Credential |
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Telephone | 804-241-9813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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