Healthcare Provider Details

I. General information

NPI: 1366066904
Provider Name (Legal Business Name): FALKE ORAL & FACIAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SOMERSETT PKWY STE B
RENO NV
89523-4924
US

IV. Provider business mailing address

3605 GRANT DR
RENO NV
89509-5301
US

V. Phone/Fax

Practice location:
  • Phone: 775-284-2500
  • Fax:
Mailing address:
  • Phone: 775-409-4614
  • Fax: 775-376-9075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: RYAN FALKE
Title or Position: DDS
Credential:
Phone: 775-284-2500