Provider Demographics
NPI:1386647873
Name:FALTAS, SAM S (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:S
Last Name:FALTAS
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 1:4 WOLF LN
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2200
Mailing Address - Country:US
Mailing Address - Phone:908-607-1858
Mailing Address - Fax:908-766-5604
Practice Address - Street 1:20 N FINLEY AVE
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1143
Practice Address - Country:US
Practice Address - Phone:908-766-1300
Practice Address - Fax:908-766-5604
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ184111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice