Provider Demographics
NPI:1265446819
Name:TOCCAFONDI, JOHN BRUNO JR (DDS, PLLC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRUNO
Last Name:TOCCAFONDI
Suffix:JR
Gender:M
Credentials:DDS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4802 E RAY RD STE 19
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6410
Mailing Address - Country:US
Mailing Address - Phone:480-893-7733
Mailing Address - Fax:
Practice Address - Street 1:4802 E RAY RD STE 19
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6410
Practice Address - Country:US
Practice Address - Phone:480-893-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040252-11223G0001X
AZD0110861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice