Provider Demographics
NPI:1609368372
Name:FALLON, JOHN FRANCIS XAVIER (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANCIS XAVIER
Last Name:FALLON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6887 DELUXE PARK
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9793
Mailing Address - Country:US
Mailing Address - Phone:315-345-2625
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-1200
Practice Address - Country:US
Practice Address - Phone:304-293-2841
Practice Address - Fax:304-293-3674
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061541-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice