NPI 1003657651

Jacob Fortenberry, DMD

Practitioner Dentist Boston, MA

Practice location

Address: 635 Albany St, Boston, MA 02118-3550
Phone: (601) 278-0923
Mailing address: 15 Beauvoir Pl, Madison, MS 39110-8047

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence DN10000426 (MA)

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Registry record

NPI: 1003657651
Entity type: Individual
Sex (as registered): Male
NPI issued: 5 Jun 2024
Record last updated: 24 Sep 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.