Provider Demographics
NPI:1124038997
Name:FONTANA, CAMILLO L (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLO
Middle Name:L
Last Name:FONTANA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1100 KINGS HWY EAST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825
Mailing Address - Country:US
Mailing Address - Phone:203-333-4700
Mailing Address - Fax:203-576-0842
Practice Address - Street 1:1817 BLACK ROCK TURNPIKE
Practice Address - Street 2:SUITE 205
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825
Practice Address - Country:US
Practice Address - Phone:203-333-4700
Practice Address - Fax:203-576-0842
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL142991223G0001X
FLDN142991223G0001X
NY507101223G0001X
CT098341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice