Healthcare Provider Details

I. General information

NPI: 1730629767
Provider Name (Legal Business Name): FALK ORAL & FACIAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date: 09/30/2020
Reactivation Date: 05/04/2023

III. Provider practice location address

6200 N DURANGO DR STE 100
LAS VEGAS NV
89149-3916
US

IV. Provider business mailing address

6200 N DURANGO DR STE 100
LAS VEGAS NV
89149-3916
US

V. Phone/Fax

Practice location:
  • Phone: 702-660-5574
  • Fax:
Mailing address:
  • Phone: 702-660-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JESSE FALK
Title or Position: OWNER
Credential: DMD
Phone: 702-660-5574