Healthcare Provider Details

I. General information

NPI: 1922440445
Provider Name (Legal Business Name): SAMUEL ANTHONY FALCONE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W WILLIAM ST
PITTSTON PA
18640-1838
US

IV. Provider business mailing address

2 W WILLIAM ST
PITTSTON PA
18640-1838
US

V. Phone/Fax

Practice location:
  • Phone: 570-655-3781
  • Fax: 570-655-3782
Mailing address:
  • Phone: 570-655-3781
  • Fax: 570-655-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS181276L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: