Provider Demographics
NPI:1962628875
Name:FONTANA, JOHN BATTISTA JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BATTISTA
Last Name:FONTANA
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:B
Other - Last Name:FONTANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD PLLC
Mailing Address - Street 1:2 STOWE ROAD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2582
Mailing Address - Country:US
Mailing Address - Phone:914-739-9260
Mailing Address - Fax:
Practice Address - Street 1:2 STOWE ROAD
Practice Address - Street 2:SUITE 10
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2582
Practice Address - Country:US
Practice Address - Phone:914-739-9260
Practice Address - Fax:914-739-9263
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist