Provider Demographics
NPI:1548381288
Name:FONSECA, JUANITA MARGO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:MARGO
Last Name:FONSECA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 LAFAYETTE RD
Mailing Address - Street 2:BUILDING E
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5455
Mailing Address - Country:US
Mailing Address - Phone:603-436-7787
Mailing Address - Fax:603-436-8597
Practice Address - Street 1:278 LAFAYETTE RD
Practice Address - Street 2:BUILDING E
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5455
Practice Address - Country:US
Practice Address - Phone:603-436-7787
Practice Address - Fax:603-436-8597
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH26541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics