Provider Demographics
NPI:1437514106
Name:JERRY N. FALK, DMD
Entity Type:Organization
Organization Name:JERRY N. FALK, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-259-3250
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-0597
Mailing Address - Country:US
Mailing Address - Phone:609-259-3250
Mailing Address - Fax:
Practice Address - Street 1:15 CARRS TAVERN ROAD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08510
Practice Address - Country:US
Practice Address - Phone:609-259-3250
Practice Address - Fax:609-259-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty