Active NPI
Gerard D Fontaine, DDS
- Dentist
- Milwaukee, WI
National Provider Identifier
1285797522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5002057
- Practice address
- 2406 W Capitol Dr
Milwaukee, WI 53206 - Phone
- (414) 445-7572
- Fax
- (414) 445-0351
- NPI assigned
- Dec 18, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 5002057 | WI | Primary |
Addresses
Primary practice location
2406 W Capitol Dr
Milwaukee, WI 53206
Mailing address
7043 W Van Beck Ave
Milwaukee, WI 53220
Phone (414) 543-5267
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33366200 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- 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 |
|---|---|---|---|---|
| I20160108000185 | WI | Order and Referring Only - Dentist | 4981906914 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5002057 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285797522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7043 W VAN BECK AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53220",
"telephone_number": "414-543-5267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2406 W CAPITOL DR",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53206",
"telephone_number": "414-445-7572",
"fax_number": "414-445-0351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTAINE",
"first_name": "GERARD",
"middle_name": "D",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5002057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33366200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
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.