Christine Ford, D.D.S

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

30102 Issued in CA

Practice address

101 Brookwood Ave
Suite 203
Santa Rosa, CA 95404-5259

Phone

(707) 568-7633

Fax

(707) 568-7321

NPI assigned

Oct 5, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720174592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BROOKWOOD AVE",
            "address_2": "SUITE 203",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954045259",
            "telephone_number": "707-568-7633",
            "fax_number": "707-568-7321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BROOKWOOD AVE",
            "address_2": "SUITE 203",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954045259",
            "telephone_number": "707-568-7633",
            "fax_number": "707-568-7321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORD",
        "first_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "30102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Margerette Fontana, DDS
• Isabella Marie Fanucci Fontana, M.S., CCC-SLP
• Alexandra Fontanilla, NP
• Afsoon Foorohar, D.O.
• Cecilia Forchette
• Jason Thomas Ford, DDS
• Forestream Acupuncture & Herbs
• William James Formaker, MFT
• Justin David Forman, B.S.
• Sherri Ann Forman, CAADE

• All providers in Santa Rosa, CA
• Periodontics in California

• 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.

Verify at the official NPI Registry.