MEDICARE: CLINTON W FALK DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1417882606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON W FALK DDS PA

Provider Business Mailing Address
First Line	:	4466 LOCKHILL SELMA RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2078
Country	:	US
Telephone Number	:	210-236-8672
Fax Number	:	210-236-9716

Provider Business Practice Location Address
First Line	:	4466 LOCKHILL SELMA RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2078
Country	:	US
Telephone Number	:	210-236-8672
Fax Number	:	210-236-9716

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	ANGELICA IRACHETA
Credential	:
Telephone Number	:	210-236-8672

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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