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General NPI Number Information
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NPI Number | 1891818191
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Entity Type | Individual
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Provider Name | NICHOLAS ANDRE FONTANA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 2877 CROOKS RD SUITE A
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City | TROY
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State | MI
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Zip | 48084-4717
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Country | US
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Telephone | 248-650-6126
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Fax |
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Provider Business Mailing Address
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Address Line | 2599 SUMMERLIN CT SUITE A
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City | ROCHESTER
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State | MI
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Zip | 48306-2290
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Country | US
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Telephone | 248-650-6126
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10219
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License Number State | MI
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