1962628875 NPI number — DR. JOHN BATTISTA FONTANA JR. DMD

Table of content: DR. JOHN BATTISTA FONTANA JR. DMD (NPI 1962628875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962628875 NPI number — DR. JOHN BATTISTA FONTANA JR. DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTANA
Provider First Name:
JOHN
Provider Middle Name:
BATTISTA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FONTANA
Provider Other First Name:
JOHN
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD PLLC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962628875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 STOWE ROAD
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
PEEKSKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10566-2582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-739-9260
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 STOWE ROAD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
PEEKSKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10566-2582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-739-9260
Provider Business Practice Location Address Fax Number:
914-739-9263
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  043759 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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