Provider Demographics
NPI:1134387160
Name:JOHN J FONDER DMD INC
Entity type:Organization
Organization Name:JOHN J FONDER DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FONDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:918-747-8802
Mailing Address - Street 1:1444 SOUTH NORFOLK AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5611
Mailing Address - Country:US
Mailing Address - Phone:918-747-8802
Mailing Address - Fax:918-584-8805
Practice Address - Street 1:1444 SOUTH NORFOLK AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5611
Practice Address - Country:US
Practice Address - Phone:918-747-8802
Practice Address - Fax:918-584-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
OK45141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty