Provider Demographics
NPI:1174638449
Name:ROUHOLLAH FALLAH DDS PA
Entity Type:Organization
Organization Name:ROUHOLLAH FALLAH DDS PA
Other - Org Name:ADVANCED DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROUHOLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-741-6556
Mailing Address - Street 1:7100 WEST COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:954-741-6556
Mailing Address - Fax:954-741-1715
Practice Address - Street 1:7100 WEST COMMERCIAL BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-741-6556
Practice Address - Fax:954-741-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty