Individual provider Active NPI

John F Fonseca, DDS

  • General Practice Dentistry
  • Santa Fe, NM
National Provider Identifier
1962780965
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5215 Issued in NM
Practice address
3600 Rodeo LN Ste D1
Santa Fe, NM 87507-5803
Phone
(505) 428-8588
NPI assigned
Jul 26, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5215 NM Primary

Addresses

Primary practice location

3600 Rodeo LN Ste D1
Santa Fe, NM 87507-5803

Mailing address

3600 Rodeo LN Ste D1
Santa Fe, NM 87507-5803
Phone (505) 438-8088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20150908000108 MI Order and Referring Only - DentistPractitioner - Dentist 8325354392

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5215NMMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Daniel M Sanchez, DDS, PC General Practice PastSince Jun 21, 2022 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1962780965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 RODEO LN STE D1",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875075803",
            "telephone_number": "505-438-8088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 RODEO LN STE D1",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875075803",
            "telephone_number": "505-428-8588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONSECA",
        "first_name": "JOHN",
        "middle_name": "F",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-26",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "5215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Fe, NM

Sources for this page

Verify at the official NPI Registry.