Provider Demographics
NPI:1629185822
Name:LAFONTAINE, EDWIN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:E
Last Name:LAFONTAINE
Suffix:
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:PALMAS PLANTATION TEE ST. #122
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-225-7514
Mailing Address - Fax:
Practice Address - Street 1:557B CALLE JULIAN RIVERA
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735
Practice Address - Country:US
Practice Address - Phone:787-885-0560
Practice Address - Fax:787-885-0560
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice