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General NPI Number Information
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NPI Number | 1720420532
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Entity Type | Organization
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Legal Business Name | JOHN B, FONTANA, III, DMD, MS, LLC
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 910 WALKER RD STE A
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City | DOVER
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State | DE
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Zip | 19904-2759
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Country | US
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Telephone | 302-734-1950
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Fax | 302-734-4097
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Provider Business Mailing Address
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Address Line | 910 WALKER RD STE A
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City | DOVER
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State | DE
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Zip | 19904-2759
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Country | US
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Telephone | 302-734-1950
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Fax | 302-734-4097
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JOHN BATTISTA FONTANA III
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Credential | D.M.D., M.S.
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Telephone | 302-734-1950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | G1-0001312
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License Number State | DE
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