Individual
RAQUEL MARIE FONTANEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1775 GRAND CONCOURSE FL 6, BRONX, NY 10453-8202
(718) 901-8110
Mailing address
1800 N FIELD ST APT 1603, DALLAS, TX 75202-2764
(787) 710-4300
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
25734
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2015
Last updated
10/25/2021
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