MEDICARE: JAMES D. FALK D.D.S.

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	1223G0001X	General Practice Dentistry	2441	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2441	OTHER	AZ	STATE LIC #

General Provider Information

NPI Number	:	1659378438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D. FALK D.D.S.

Provider Business Mailing Address
First Line	:	720 E THUNDERBIRD RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5396
Country	:	US
Telephone Number	:	602-863-3000
Fax Number	:	602-942-5249

Provider Business Practice Location Address
First Line	:	720 E THUNDERBIRD RD
Second Line	:	# 2
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5396
Country	:	US
Telephone Number	:	602-863-3000
Fax Number	:	602-942-5249

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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