Provider Demographics
NPI:1467405456
Name:DENTAL HEALTH CENTER, DDS, PA
Entity Type:Organization
Organization Name:DENTAL HEALTH CENTER, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:S
Authorized Official - Last Name:FALKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-463-2300
Mailing Address - Street 1:19645 PILOT KNOB RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7239
Mailing Address - Country:US
Mailing Address - Phone:651-463-2300
Mailing Address - Fax:651-463-2118
Practice Address - Street 1:19645 PILOT KNOB RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7239
Practice Address - Country:US
Practice Address - Phone:651-463-2300
Practice Address - Fax:651-463-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8018122300000X
MN10404122300000X
MN10522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN691375000OtherMEDICAL ASSIST