Healthcare Provider Details

I. General information

NPI: 1164519740
Provider Name (Legal Business Name): DAN J FALKE L.I.C.D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

2018 ROCKDELL DR
FAIRBORN OH
45324-2529
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-267-5389
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number913127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: