Provider Demographics
NPI:1639289788
Name:FALKOFF, JEROME MARK (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:MARK
Last Name:FALKOFF
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 N JACKSON
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2446
Mailing Address - Country:US
Mailing Address - Phone:870-234-0450
Mailing Address - Fax:870-234-5662
Practice Address - Street 1:912 N JACKSON
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2446
Practice Address - Country:US
Practice Address - Phone:870-234-0450
Practice Address - Fax:870-234-5662
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58827OtherBLUE CROSS
AR849579OtherUNITED CONCORDIA