Provider Demographics
NPI:1629456090
Name:FALLERONI DENTAL LLC
Entity Type:Organization
Organization Name:FALLERONI DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLERONI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-222-1020
Mailing Address - Street 1:801 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3347
Mailing Address - Country:US
Mailing Address - Phone:724-222-1020
Mailing Address - Fax:724-222-7751
Practice Address - Street 1:801 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3347
Practice Address - Country:US
Practice Address - Phone:724-222-1020
Practice Address - Fax:724-222-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025177L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1306808449Medicare PIN