Healthcare Provider Details

I. General information

NPI: 1710046297
Provider Name (Legal Business Name): CHRISTOPHER J. FALVELLO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 W JUNIPER ST
HAZLETON PA
18201-6410
US

IV. Provider business mailing address

59 W JUNIPER ST
HAZLETON PA
18201-6410
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-2551
  • Fax: 570-459-2448
Mailing address:
  • Phone: 570-459-2551
  • Fax: 570-459-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS027392L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012244560001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: