Healthcare Provider Details

I. General information

NPI: 1225726201
Provider Name (Legal Business Name): FERNANDO ALBERTO FALCON ANDARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 LEAVITT RD
LORAIN OH
44053-2136
US

IV. Provider business mailing address

4785 LEAVITT RD
LORAIN OH
44053-2136
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-6677
  • Fax:
Mailing address:
  • Phone: 440-282-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028144
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028144
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: