Provider Demographics
NPI:1659454379
Name:FONTANEZ, FRANCISCO (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:
Last Name:FONTANEZ
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:MSC 180, 100 GRAND BOULEVARD PASEOS
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CUPEY PROFESSIONAL MALL SUITE 102
Practice Address - Street 2:359 AVE SAN CLAUDIO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-769-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9240103OtherHUMANA
PR42556FOOtherSSS (TRIPLE-S)
PRDN02591OtherUIA
PR206956OtherPREFERRED HEALTH (UTI)