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General NPI Number Information
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NPI Number | 1013532324
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Entity Type | Organization
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Legal Business Name | CHRISTINE A FORTMANN DDS INC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 32281 CAMINO CAPISTRANO STE C102
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3784
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Country | US
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Telephone | 949-429-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 32281 CAMINO CAPISTRANO STE C102
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3784
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Country | US
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Telephone | 949-429-8833
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE FORTMANN
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Credential | DDS
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Telephone | 949-429-8833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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