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General NPI Number Information
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NPI Number | 1205997442
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Entity Type | Individual
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Provider Name | BRUCE DOUGLAS FALK DDS
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 49949 350TH ST
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City | SALOL
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State | MN
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Zip | 56756-9609
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Country | US
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Telephone | 218-463-1828
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Fax | 218-463-3013
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Provider Business Mailing Address
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Address Line | 49949 350TH ST
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City | SALOL
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State | MN
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Zip | 56756-9609
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Country | US
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Telephone | 218-463-1828
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Fax | 218-463-3013
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D8236
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License Number State | MN
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