FONTAINE DENTAL GROUP (NPI# 1558591123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558591123 |
| Entity Type | Organization |
| Organization Name | FONTAINE DENTAL GROUP |
| Practice Address |
9301 Wicker Ave Saint John IN 46373-9403 |
| Practice Telephone | 2193657773 |
| Practice Fax Number | 2193658883 |
| Mailing Telephone | 2193657773 |
| Mailing Fax Number | 2193658883 |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2009-07-17 |
| Authorized Official Name | JENNIFER JOY FONTAINE (DDS) |
| Authorized Official Telephone | 2193657773 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 12010668 | IN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | LICENSE | 12010668 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | FONTAINE DENTAL GROUP, P.C. | 10895 Park Place, St. John, IN 46373 |
| Street Address |
9301 WICKER AVE |
| City | SAINT JOHN |
| State | IN |
| Zip Code | 46373-9403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023641123 | Lisa A Arteaga | Occupational Therapy Assistant | 10700 Park Place of St John, St John, IN 46373 | 2020-02-17 |
| 1306493507 | Athletico Ltd | Physical Therapist | 10081 Wicker Ave #4, Saint John, IN 46373 | 2019-08-22 |
| 1083014971 | Courtney Olavarria | Registered Nurse | 8915 West 93rd Avenue, Clark Middle School, Saint John, IN 46373 | 2014-08-27 |
| 1316368111 | Tracy Lynn Wargo | Registered Nurse | 8801 Wicker Ave., Kolling Elementary, St. John, IN 46373 | 2013-12-20 |
| 1245587989 | Joshua Dejong | Physical Therapist | 10200 Wicker Ave Ste 1, Saint John, IN 46373 | 2012-08-13 |
| 1053406629 | Corlin Alden Stein | Chiropractor | 9161 Wicker Avenue (us 41), St. John, IN 46373 | 2006-10-03 |
| 1235190216 | Tarak R Chokshi | Internal Medicine | 10200 Wicker Avenue, St John, IN 46373 | 2006-03-30 |
| 1154397057 | Norbert A Matulis | Dentist | 9207 Wicker Avenue, St John, IN 46373 | 2006-02-28 |
| 1568462729 | Keith R. Pitchford | Orthopaedic Surgery | 9615 Keilman Street, Saint John, IN 46373 | 2005-07-28 |
| 1528483021 | Creating Smiles PC | Dentist | 8217 Wicker Ave, St John, IN 46373 | 2014-02-20 |
| Find all providers in zip 46373 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891101622 | Saba Najamuddin | Dentist | 10895 Park Pl, Saint John, IN 46373-8630 | 2014-07-01 |
| 1366705956 | Stephen Fugaj | Dentist | 9207 Wicker Ave, Saint John, IN 46373-9782 | 2012-06-19 |
| 1184944159 | Rachel Marie Dunlop | Dentist | 9270 Wicker Ave Ste Eandf, Saint John, IN 46373-8508 | 2010-06-01 |
| 1174617237 | Charles T. Mccarroll | Dentist | 10033 Wicker Ave Ste 9, Saint John, IN 46373-8777 | 2006-10-03 |
| 1275855108 | John Eric Steinmueller | Dentist | 10200 Wicker Ave, Ste 2, Saint John, IN 46373-9439 | 2010-02-19 |
| 1811162605 | Smile Solutions Inc | Dentist | 8217 Wicker Ave, Saint John, IN 46373-8878 | 2008-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023615796 | Himabindu Gogeneni | Dentist | 3575 Portage Ave Ste A, South Bend, IN 46628-6092 | 2020-10-06 |
| 1770193591 | Urgent Dental Center Sw LLC | Dentist | 2907 Kentucky Ave Ste A, Indianapolis, IN 46221-2103 | 2020-08-06 |
| 1134737026 | Gelsy Calvo Hernandez | Dentist | 1519 Us Highway 41 Ste B8, Schererville, IN 46375-1373 | 2020-07-17 |
| 1508483611 | Monica Vance | Dentist | 1711 S State Road 135 Ste B, Greenwood, IN 46143-6481 | 2020-07-06 |
| 1265059828 | Yuen Ting Chan | Dentist | 5240 Franklin St, Michigan City, IN 46360-7372 | 2020-06-30 |
| 1962028829 | Knobs Damily Dental, LLC | Dentist | 3684 Us-150 #9, Floyds Knobs, IN 47119 | 2020-06-17 |
| 1962026948 | Maria Contreras Mantilla | Dentist | 1320 W Bloomfield Rd, Bloomington, IN 47403-2001 | 2020-06-04 |
| 1801410931 | Briana Michelle Maddox | Dentist | 35 S Creasy Ln Ste 3, Lafayette, IN 47905-5254 | 2020-06-04 |
| 1639793870 | Bryan Schmidt | Dentist | 1639 North Cass St, Wabash, IN 46992 | 2020-06-03 |
| 1861027732 | Kendall Thomas Sands | Dentist | 508 Indiana Ave # 3106, Indianapolis, IN 46202-3106 | 2020-03-11 |
| Find all providers with the same taxonomy | ||||
| City | SAINT JOHN |
| Zip Code | 46373 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.