Provider Demographics
NPI:1285299347
Name:FOUNTAIN, JOSHUA DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DEAN
Last Name:FOUNTAIN
Suffix:
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 1:851 GREENSIDE DR APT 1222
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1156
Mailing Address - Country:US
Mailing Address - Phone:903-571-1222
Mailing Address - Fax:
Practice Address - Street 1:3302 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2013
Practice Address - Country:US
Practice Address - Phone:214-828-8137
Practice Address - Fax:214-874-4553
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice