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General NPI Number Information
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NPI Number | 1316162951
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Entity Type | Individual
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Provider Name | MATTHEW EDWARD FORTNA DMD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 10261 ROUTE 60 SUITE 2
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City | FREDONIA
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State | NY
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Zip | 14063-1419
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Country | US
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Telephone | 716-672-2002
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Fax | 716-672-2012
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Provider Business Mailing Address
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Address Line | 3478 STONE QUARRY RD
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City | FREDONIA
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State | NY
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Zip | 14063-9791
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Country | US
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Telephone | 716-672-2270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 053346
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License Number State | NY
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