Southfield Dental PLLC
NPI 1104067644ActiveOrganization· Dentist· Southfield, MI
Dentist in Southfield, Michigan, registered in NPPES in March 2009. The authorized official on file is Raymond A. Fortson, DDS, Member.
Overview
| NPI | 1104067644 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 12, 2009 |
| Last updated in NPPES | Mar 12, 2009 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | 2901014077 | MI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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