Provider Demographics
NPI:1538516083
Name:MCINTOSH FALCON, KATIUSKA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KATIUSKA
Middle Name:
Last Name:MCINTOSH FALCON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATIUSKA
Other - Middle Name:
Other - Last Name:MC INTOSH FALCON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 279517
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-9517
Mailing Address - Country:US
Mailing Address - Phone:863-808-9526
Mailing Address - Fax:
Practice Address - Street 1:10051 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6186
Practice Address - Country:US
Practice Address - Phone:863-808-9526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-14
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 22233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist