Provider Demographics
NPI:1649261439
Name:BAMONTE, JOHN A JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BAMONTE
Suffix:JR
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 1:101 N MEADOWS DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8368
Mailing Address - Country:US
Mailing Address - Phone:724-934-3844
Mailing Address - Fax:724-934-3851
Practice Address - Street 1:101 N MEADOWS DR
Practice Address - Street 2:SUITE 121
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8368
Practice Address - Country:US
Practice Address - Phone:724-934-3844
Practice Address - Fax:724-934-3851
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024033L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
011269OtherAETNA
451379Medicare ID - Type Unspecified
U09280Medicare UPIN