Provider Demographics
NPI:1174721476
Name:FORTUNATO, JAMES PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:FORTUNATO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3819
Mailing Address - Country:US
Mailing Address - Phone:775-888-6887
Mailing Address - Fax:
Practice Address - Street 1:917 MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3819
Practice Address - Country:US
Practice Address - Phone:775-888-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-07
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4072122300000X
CA36363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist