Provider Demographics
NPI:1568661932
Name:FONTANELLA, JOAN M (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:M
Last Name:FONTANELLA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3297 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2655
Mailing Address - Country:US
Mailing Address - Phone:617-983-6070
Mailing Address - Fax:617-983-0434
Practice Address - Street 1:3297 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2655
Practice Address - Country:US
Practice Address - Phone:617-983-6070
Practice Address - Fax:617-983-0434
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7044124Q00000X
124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist