Healthcare Provider Details

I. General information

NPI: 1013067347
Provider Name (Legal Business Name): VICTOR MANUEL FALCON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELLA VISTA GARDENS D-10B CALLE 2
BAYAMON PUERTO RICO
00957
UM

IV. Provider business mailing address

PO BOX 4167
BAYAMON PUERTO RICO
00958
UM

V. Phone/Fax

Practice location:
  • Phone: 787-799-5130
  • Fax: 787-279-0063
Mailing address:
  • Phone: 787-799-5130
  • Fax: 787-279-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1287
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: