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General NPI Number Information
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NPI Number | 1467538710
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Entity Type | Individual
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Provider Name | JUSTIN GEORGE FONTANINI DOM, AP
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Gender | Male
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Dates
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Enumeration Date | 10/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9070 58TH DR E SUITE 101
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-6110
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Country | US
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Telephone | 941-752-4838
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Fax |
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Provider Business Mailing Address
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Address Line | 6301 58TH ST APT 1003
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City | PINELLAS PARK
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State | FL
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Zip | 33781-5513
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Country | US
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Telephone | 727-547-1956
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2220
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License Number State | FL
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