Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Audrey Lee Fortin, DMD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1922688001

Audrey Lee Fortin, DMD is a Student in an Organized Health Care Education/Training Program in Jackson, Mississippi. Practices as a sole proprietor and works from 2 locations. Licensed in Mississippi.

Licensed in
MS
In the registry since
2021
Specialties on file
2
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

989 Ellis Ave
Jackson, MS 39209-6256
Phone: (769) 235-3919
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 649 Muirwood Cir, Ridgeland, MS 39157-3623 — (662) 560-7211

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 4289-22 (MS)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1922688001
Entity typeIndividual (Type 1)
GenderFemale
Credentials DMD
Sole proprietorYes
NPI enumeratedApril 12, 2021
Last updated in NPPESJuly 7, 2022
Certification dateJuly 7, 2022

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