MEDICARE: FALAMACK ZALTASH D.D.S INC.,

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	122300000X	Dentist	40769	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B40769	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1528105319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALAMACK ZALTASH D.D.S INC.,

Provider Business Mailing Address
First Line	:	410 S GLENDORA AVE
Second Line	:	SUITE 150
City	:	GLENDORA
State	:	CA
Zip	:	91741-6207
Country	:	US
Telephone Number	:	626-967-6767
Fax Number	:	626-966-2986

Provider Business Practice Location Address
First Line	:	410 S GLENDORA AVE
Second Line	:	SUITE 150
City	:	GLENDORA
State	:	CA
Zip	:	91741-6207
Country	:	US
Telephone Number	:	626-967-6767
Fax Number	:	626-966-2986

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. FALAMACK ZALTASH
Credential	:	D.D.S
Telephone Number	:	626-967-6767

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	05/19/2023

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