Provider Demographics
NPI:1962424150
Name:FONTAINE, JOHN A (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:FONTAINE
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:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-0085
Mailing Address - Country:US
Mailing Address - Phone:978-827-5544
Mailing Address - Fax:
Practice Address - Street 1:435 MAIN ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-8026
Practice Address - Country:US
Practice Address - Phone:978-343-8380
Practice Address - Fax:978-345-1301
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA126951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice