Provider Demographics
NPI:1720420532
Name:JOHN B, FONTANA, III, DMD, MS, LLC
Entity Type:Organization
Organization Name:JOHN B, FONTANA, III, DMD, MS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BATTISTA
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:302-734-1950
Mailing Address - Street 1:910 WALKER RD STE A
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2759
Mailing Address - Country:US
Mailing Address - Phone:302-734-1950
Mailing Address - Fax:302-734-4097
Practice Address - Street 1:910 WALKER RD STE A
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2759
Practice Address - Country:US
Practice Address - Phone:302-734-1950
Practice Address - Fax:302-734-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00013121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty