Donald A Fantuzzo, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010681A Issued in IN

Practice address

1690 S Ohio St
Martinsville, IN 46151-3317

Phone

(765) 342-8435

Fax

(765) 457-9310

NPI assigned

Sep 1, 2006

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Donald a Fantuzzo DDS PC

  • General Practice Dentistry
  • Kokomo, IN
  • NPI 1740382928
  NPD (past) Authorized official
• Donald Fantuzzo, DDS, Inc.

  • Dental Clinic/Center
  • Martinsville, IN
  • NPI 1679125504
  NPD (past) Authorized official

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1861594061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6414 LITTLE FLOCK RD",
            "city": "SPENCER",
            "state": "IN",
            "postal_code": "474605889",
            "telephone_number": "812-876-4179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 S OHIO ST",
            "city": "MARTINSVILLE",
            "state": "IN",
            "postal_code": "461513317",
            "telephone_number": "765-342-8435",
            "fax_number": "765-457-9310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTUZZO",
        "first_name": "DONALD",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010681A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Martinsville, IN
• Providers in Martinsville, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.