Healthcare Provider Details

I. General information

NPI: 1053422022
Provider Name (Legal Business Name): JENNIFER J FONTAINE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8918 LANTANA RD STE B
LAKE WORTH FL
33467-6136
US

IV. Provider business mailing address

8918 LANTANA RD STE B
LAKE WORTH FL
33467-6136
US

V. Phone/Fax

Practice location:
  • Phone: 561-801-1044
  • Fax: 561-801-1044
Mailing address:
  • Phone: 561-801-1044
  • Fax: 561-801-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31439
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010668A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: