Healthcare Provider Details

I. General information

NPI: 1295453173
Provider Name (Legal Business Name): FALCON DENTAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20690 VERNIER RD
HARPER WOODS MI
48225-1415
US

IV. Provider business mailing address

20690 VERNIER RD
HARPER WOODS MI
48225-1415
US

V. Phone/Fax

Practice location:
  • Phone: 313-884-3050
  • Fax: 313-884-0007
Mailing address:
  • Phone: 313-884-3050
  • Fax: 313-884-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HORACIO ENRIQUE FALCON
Title or Position: DENTISIT
Credential: DDS
Phone: 313-884-3050