Provider Demographics
NPI:1447329230
Name:RONALD C FONTANESI DDS PC
Entity type:Organization
Organization Name:RONALD C FONTANESI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FONTANESI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-855-4143
Mailing Address - Street 1:6443 INKSTER RD
Mailing Address - Street 2:SUITE 176
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1303
Mailing Address - Country:US
Mailing Address - Phone:248-855-4143
Mailing Address - Fax:248-866-4143
Practice Address - Street 1:6443 INKSTER RD
Practice Address - Street 2:SUITE 176
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1303
Practice Address - Country:US
Practice Address - Phone:248-855-4143
Practice Address - Fax:248-866-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901009836OtherDENTAL LICENCE