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DR. CHARLES ROBERT FORT DMD
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1346328812
Individual Registrant:DR. CHARLES ROBERT FORT DMD
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
330 EAST BROADWAY STREET FORT MEADE, FL 33841 US
Tel: 863-285-7121 Fax: 863-285-8648
Tel: 863-285-7121 Fax: 863-285-8648
Contact information for business:
330 EAST BROADWAY STREET FORT MEADE, FL 33841 US
Tel: 863-285-7121 Fax: 863-285-8648
Tel: 863-285-7121 Fax: 863-285-8648
Registration Information:
NPI: 1346328812
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 122300000X | Dental Providers Dentist | FL | 8002 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
