Provider Demographics
NPI:1295187094
Name:DENTISTRY FOR HEATH
Entity Type:Organization
Organization Name:DENTISTRY FOR HEATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:FALBO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-470-7304
Mailing Address - Street 1:3724 MASON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1837
Mailing Address - Country:US
Mailing Address - Phone:651-470-7304
Mailing Address - Fax:
Practice Address - Street 1:10365 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4713
Practice Address - Country:US
Practice Address - Phone:651-470-7304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7328305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization