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NPI Code Detail

MEDICARE: KEVIN J FORTIER DDS

MEDICARE: KEVIN J FORTIER DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry41831CA

General Provider Information

NPI Number : 1013118371
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN J FORTIER DDS
Provider Business Mailing Address
First Line : 11702 BEACH BLVD
Second Line :
City : STANTON
State : CA
Zip : 90680-3609
Country : US
Telephone Number : 714-898-8552
Fax Number : 714-799-5633
Provider Business Practice Location Address
First Line : 11702 BEACH BLVD
Second Line :
City : STANTON
State : CA
Zip : 90680-3609
Country : US
Telephone Number : 714-898-8552
Fax Number : 714-799-5633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2007
Last Update Date : 07/08/2007

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Directions to “ KEVIN J FORTIER DDS” Practice Location

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