Healthcare Provider Details

I. General information

NPI: 1659187193
Provider Name (Legal Business Name): MERLYN MOLINA FALCO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 YALE AVE
TURLOCK CA
95382-0813
US

IV. Provider business mailing address

333 SAN CARLOS WAY
STOCKTON CA
95207-1956
US

V. Phone/Fax

Practice location:
  • Phone: 786-479-7439
  • Fax:
Mailing address:
  • Phone: 209-536-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: