Provider Demographics
NPI:1033893045
Name:COLETTE FONTAINE, RDHAP INC.
Entity Type:Organization
Organization Name:COLETTE FONTAINE, RDHAP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST AP
Authorized Official - Prefix:MS
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH,RDHAP
Authorized Official - Phone:650-520-0396
Mailing Address - Street 1:85 W 5TH AVE APT 407
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2036
Mailing Address - Country:US
Mailing Address - Phone:650-520-0396
Mailing Address - Fax:
Practice Address - Street 1:85 W 5TH AVE APT 407
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2036
Practice Address - Country:US
Practice Address - Phone:650-264-9164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty