Provider Demographics
NPI:1639289242
Name:FONTANA, LINDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:FONTANA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739
Mailing Address - Country:US
Mailing Address - Phone:732-747-5002
Mailing Address - Fax:732-747-6646
Practice Address - Street 1:466 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739
Practice Address - Country:US
Practice Address - Phone:732-747-5002
Practice Address - Fax:732-747-6646
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI185161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice