Organization
VINCENT FONTANA, JR., D.D.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCENT FONTANA JR. D.D.S. (PRESIDENT)
(210) 826-9523
Entity
Organization
Contact information
Practice address
207 W SUNSET RD, SAN ANTONIO, TX 78209-2634
(210) 826-9523
(210) 826-9524
Mailing address
207 W SUNSET RD, SAN ANTONIO, TX 78209-2634
(210) 826-9523
(210) 826-9524
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
10506
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
821950
UNITED CONCORDIA
TX
01
—
D10506
BLUE CROSS BLUE SHIELD
TX
01
—
TXB113099
MEDICARE
—
Enumeration date
05/24/2005
Last updated
03/04/2014
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