Provider Demographics
NPI:1801927025
Name:FONTANA, JOHN B JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:FONTANA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 LOVERING AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2141
Mailing Address - Country:US
Mailing Address - Phone:302-652-5312
Mailing Address - Fax:302-652-8679
Practice Address - Street 1:1702 LOVERING AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2141
Practice Address - Country:US
Practice Address - Phone:302-652-5312
Practice Address - Fax:302-652-8679
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE861122300000X
DE0861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510342588OtherTAX ID