MEDICARE: JOSEPH PRICE FALLIN DDS

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	1223G0001X	General Practice Dentistry	3649	OK

General Provider Information

NPI Number	:	1811143894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH PRICE FALLIN DDS

Provider Business Mailing Address
First Line	:	4301 NW 63RD ST
Second Line	:	SUITE 303
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1549
Country	:	US
Telephone Number	:	405-848-2886
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 NW 63RD ST
Second Line	:	SUITE 303
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1549
Country	:	US
Telephone Number	:	405-848-2886
Fax Number	:

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

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	08/11/2008

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