MEDICARE: DR. JAMES PATRICK FORTUNATO D.D.S.

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
1	122300000X	Dentist	4072	NV
2	122300000X	Dentist	36363	CA

General Provider Information

NPI Number	:	1174721476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES PATRICK FORTUNATO D.D.S.

Provider Business Mailing Address
First Line	:	917 MOUNTAIN ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-3819
Country	:	US
Telephone Number	:	775-888-6887
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 MOUNTAIN ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-3819
Country	:	US
Telephone Number	:	775-888-6887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2007
Last Update Date	:	06/16/2011

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