Provider Demographics
NPI:1073635512
Name:FALK, THEODORE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:S
Last Name:FALK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3707
Mailing Address - Country:US
Mailing Address - Phone:559-229-3556
Mailing Address - Fax:559-229-3557
Practice Address - Street 1:1207 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3707
Practice Address - Country:US
Practice Address - Phone:559-229-3556
Practice Address - Fax:559-229-3557
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice