# DONALD A FANTUZZO DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740382928
- **Authorized official:** DONALD ARDEN FANTUZZO DDS (OWNER DENTIST)
- **Authorized official phone:** (765) 457-8359

## Contact information

- **Practice address:** 2196 W SYCAMORE ST, KOKOMO, IN 46901
- **Practice address phone:** (765) 457-8359
- **Practice address fax:** (765) 457-9310
- **Mailing address:** 2196 W SYCAMORE ST, KOKOMO, IN 46901
- **Mailing address phone:** (765) 457-8359
- **Mailing address fax:** (765) 457-9310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12010681A | IN | Yes |

## Other

- **Enumeration date:** 09/01/2006
- **Last updated:** 08/22/2020