Provider Demographics
NPI:1336418151
Name:FONTANA, JOHN BATTISTA III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BATTISTA
Last Name:FONTANA
Suffix:III
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 1:910 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
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14567122300000X
DEG1-0001312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist