Provider Demographics
NPI:1437171808
Name:FALTISCO, DANIEL ALOYSIUS I (DDS)
Entity Type:Individual
Prefix:MISS
First Name:DANIEL
Middle Name:ALOYSIUS
Last Name:FALTISCO
Suffix:I
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 1:16 W MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-2117
Mailing Address - Country:US
Mailing Address - Phone:716-672-2980
Mailing Address - Fax:
Practice Address - Street 1:16 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-2117
Practice Address - Country:US
Practice Address - Phone:716-672-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052657-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist