Provider Demographics
NPI:1144472713
Name:FALEMBAN, MOUNIKA (DDS)
Entity type:Individual
Prefix:
First Name:MOUNIKA
Middle Name:
Last Name:FALEMBAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1543
Mailing Address - Country:US
Mailing Address - Phone:813-408-4634
Mailing Address - Fax:
Practice Address - Street 1:13127 KINGS LAKE DR UNIT 101
Practice Address - Street 2:
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534-3958
Practice Address - Country:US
Practice Address - Phone:813-677-3047
Practice Address - Fax:813-284-7959
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18289122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2188062Medicaid
FL1144472713OtherDENTAQUEST
FL007161100Medicaid
FL9309OtherMCNA