Provider Demographics
NPI:1134287329
Name:FONTAINE, ALBERT J JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:J
Last Name:FONTAINE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 PINEHURST ROAD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698
Mailing Address - Country:US
Mailing Address - Phone:727-734-5242
Mailing Address - Fax:727-736-1117
Practice Address - Street 1:1418 PINEHURST ROAD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-734-3452
Practice Address - Fax:727-736-1117
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN104881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics