Provider Demographics
NPI:1013910009
Name:VINCENT FONTANA, JR., D.D.S., INC.
Entity Type:Organization
Organization Name:VINCENT FONTANA, JR., D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-826-9523
Mailing Address - Street 1:207 W SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2634
Mailing Address - Country:US
Mailing Address - Phone:210-826-9523
Mailing Address - Fax:210-826-9524
Practice Address - Street 1:207 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2634
Practice Address - Country:US
Practice Address - Phone:210-826-9523
Practice Address - Fax:210-826-9524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10506261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB113099OtherMEDICARE
TXD10506OtherBLUE CROSS BLUE SHIELD
TX821950OtherUNITED CONCORDIA
TXD10506OtherBLUE CROSS BLUE SHIELD