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

Dr. Cory Fortson

Individual provider Dentist · NPI 1306258280

Dr. Cory Fortson is a Dentist in Southfield, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in
MI
In the registry since
2014
Specialties on file
2

Practice location Address checks out

17600 W 12 Mile Rd Ste 3
Southfield, MI 48076-1910
Phone: (248) 569-6722
Fax: (248) 569-7409
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 2901021215 (MI)
Dentist Taxonomy 122300000X · Licence 2901021215 (MI)

Record details

NPI number1306258280
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 27, 2014
Last updated in NPPESMay 8, 2024
Certification dateMay 8, 2024
Mailing address17600 W 12 Mile Rd Ste 3, Southfield, MI 48076-1910

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