Provider Demographics
NPI:1013009968
Name:FALLON, THOMAS J (DDSPC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:FALLON
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Gender:M
Credentials:DDSPC
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Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE #3M
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-452-2570
Mailing Address - Fax:315-452-2573
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE #3M NORTH MEDICAL CENTER
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2570
Practice Address - Fax:315-452-2573
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY032133-11223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology