MEDICARE: DR. MICHAEL ROBERT FONTANA DMD, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019730	PA

General Provider Information

NPI Number	:	1093868713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ROBERT FONTANA DMD, P.C.

Provider Business Mailing Address
First Line	:	8791 BARNES LAKE RD
Second Line	:	SUITE 203
City	:	IRWIN
State	:	PA
Zip	:	15642-3176
Country	:	US
Telephone Number	:	724-863-5077
Fax Number	:	724-863-9590

Provider Business Practice Location Address
First Line	:	8791 BARNES LAKE RD
Second Line	:	SUITE 203
City	:	IRWIN
State	:	PA
Zip	:	15642-3176
Country	:	US
Telephone Number	:	724-863-5077
Fax Number	:	724-863-9590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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