| Fontaine Dental Group | |
|
9301 Wicker Ave Saint John IN 46373-9403 | |
| (219) 365-7773 | |
| (219) 365-8883 |
| Full Name | Fontaine Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 9301 Wicker Ave, Saint John, Indiana |
| Authorized Official Name and Position | Jennifer Joy Fontaine (DDS) |
| Authorized Official Contact | 2193657773 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fontaine Dental Group 9301 Wicker Ave Saint John IN 46373-9403 Ph: (219) 365-7773 | Fontaine Dental Group 9301 Wicker Ave Saint John IN 46373-9403 Ph: (219) 365-7773 |
| NPI Number | 1558591123 |
|---|---|
| Provider Enumeration Date | 07/17/2009 |
| Last Update Date | 07/17/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558591123 | NPI | - | NPPES |
| 12010668 | Other | IN | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12010668 (Indiana) | Primary |
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