MEDICARE: DR. ALA ALLAN FALLAH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN 17085	FL

General Provider Information

NPI Number	:	1184628711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALA ALLAN FALLAH DMD

Provider Business Mailing Address
First Line	:	1207 BRUCE B. DOWNS BLVD
Second Line	:	SUITE 1
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543
Country	:	US
Telephone Number	:	813-994-4200
Fax Number	:	813-994-9996

Provider Business Practice Location Address
First Line	:	1207 BRUCE B. DOWNS BLVD.
Second Line	:	STE 1
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543
Country	:	US
Telephone Number	:	813-994-4200
Fax Number	:	813-994-9996

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/02/2008

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