Healthcare Provider Details

I. General information

NPI: 1801223540
Provider Name (Legal Business Name): FALLON FAMILY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W A ST
FALLON NV
89406-2947
US

IV. Provider business mailing address

300 W A ST
FALLON NV
89406-2947
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-5213
  • Fax: 775-423-9602
Mailing address:
  • Phone: 775-423-5213
  • Fax: 775-423-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5894
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARY JAQUES
Title or Position: PARTNER
Credential:
Phone: 775-423-5213