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General NPI Number Information
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NPI Number | 1568224269
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Entity Type | Organization
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Legal Business Name | FALLON DENTAL ARTS, PLLC
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 6 PARC PL STE C
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City | SOUTHAMPTON
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State | MA
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Zip | 01073-9270
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Country | US
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Telephone | 413-203-1919
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Fax | 413-203-5090
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Provider Business Mailing Address
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Address Line | 154 RACHAEL TER
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City | WESTFIELD
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State | MA
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Zip | 01085-1881
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Country | US
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Telephone | 413-636-1591
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. ANDREA FALLON
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Credential | DMD
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Telephone | 413-636-1591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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