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Individual

GERARD D FONTAINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
2406 W CAPITOL DR, MILWAUKEE, WI 53206
(414) 445-7572
(414) 445-0351
Mailing address
7043 W VAN BECK AVE, MILWAUKEE, WI 53220
(414) 543-5267

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5002057
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
33366200
WI
Enumeration date
12/18/2006
Last updated
07/08/2007
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