Healthcare Provider Details

I. General information

NPI: 1144472713
Provider Name (Legal Business Name): MOUNIKA FALEMBAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13127 KINGS LAKE DR UNIT 101
GIBSONTON FL
33534-3958
US

IV. Provider business mailing address

6815 SCENIC DR
APOLLO BEACH FL
33572-1543
US

V. Phone/Fax

Practice location:
  • Phone: 813-677-3047
  • Fax: 813-284-7959
Mailing address:
  • Phone: 813-408-4634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number18289
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number18289
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: