MEDICARE: FALLS DENTAL GROUP LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223G0001X	General Practice Dentistry
3	1223P0700X	Prosthodontics

General Provider Information

NPI Number	:	1962533588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALLS DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	N88W17001 MAIN ST
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-2828
Country	:	US
Telephone Number	:	262-251-6070
Fax Number	:	262-250-9000

Provider Business Practice Location Address
First Line	:	N88W17001 MAIN ST
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-2828
Country	:	US
Telephone Number	:	262-251-6070
Fax Number	:	262-250-9000

Authorized Official
Title or Position	:	OWNER
Name	:	DR. N. GENE PITTMAN
Credential	:	D.D.S.
Telephone Number	:	262-251-6070

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	09/11/2025

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