Active NPI
Michael Robert Fontana, DMD, P.C.
- Dentist
- Irwin, PA
National Provider Identifier
1093868713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019730
- Practice address
- 8791 Barnes Lake Rd
Suite 203
Irwin, PA 15642-3176 - Phone
- (724) 863-5077
- Fax
- (724) 863-9590
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019730 | PA | Primary |
Addresses
Primary practice location
8791 Barnes Lake Rd
Suite 203
Irwin, PA 15642-3176
Mailing address
8791 Barnes Lake Rd
Suite 203
Irwin, PA 15642-3176
Phone (724) 863-5077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150331000201 | PA | Order and Referring Only - Dentist | 3072830165 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019730 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093868713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8791 BARNES LAKE RD",
"address_2": "SUITE 203",
"city": "IRWIN",
"state": "PA",
"postal_code": "156423176",
"telephone_number": "724-863-5077",
"fax_number": "724-863-9590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8791 BARNES LAKE RD",
"address_2": "SUITE 203",
"city": "IRWIN",
"state": "PA",
"postal_code": "156423176",
"telephone_number": "724-863-5077",
"fax_number": "724-863-9590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTANA",
"first_name": "MICHAEL",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "DMD, P.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "019730",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irwin, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.