Provider Demographics
NPI:1114918497
Name:FALLON, STEVEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:FALLON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 BERKSHIRE BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1264
Mailing Address - Country:US
Mailing Address - Phone:610-374-4093
Mailing Address - Fax:610-375-6454
Practice Address - Street 1:1075 BERKSHIRE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1264
Practice Address - Country:US
Practice Address - Phone:610-374-4093
Practice Address - Fax:610-375-6454
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0370501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery