Provider Demographics
NPI:1629111216
Name:FALCONE, DOMINICK JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:JOSEPH
Last Name:FALCONE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 BLACKWOOD-CLEMENTON RD.
Mailing Address - Street 2:STE B
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-232-7772
Mailing Address - Fax:856-232-4626
Practice Address - Street 1:1546 BLACKWOOD-CLEMENTON RD.
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-232-7772
Practice Address - Fax:856-232-4626
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD I 157091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice