Provider Demographics
NPI:1548376957
Name:FORTNEY, CHRISTIAN MERIT (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:MERIT
Last Name:FORTNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4109
Mailing Address - Country:US
Mailing Address - Phone:760-489-0330
Mailing Address - Fax:760-489-1330
Practice Address - Street 1:230 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4109
Practice Address - Country:US
Practice Address - Phone:760-489-0330
Practice Address - Fax:760-489-1330
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics