Provider Demographics
NPI:1639589989
Name:BRUCE D. FALK
Entity Type:Organization
Organization Name:BRUCE D. FALK
Other - Org Name:FALK DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-463-1828
Mailing Address - Street 1:49949 350TH ST
Mailing Address - Street 2:
Mailing Address - City:SALOL
Mailing Address - State:MN
Mailing Address - Zip Code:56756-9609
Mailing Address - Country:US
Mailing Address - Phone:218-463-1828
Mailing Address - Fax:218-463-3013
Practice Address - Street 1:49949 350TH ST
Practice Address - Street 2:
Practice Address - City:SALOL
Practice Address - State:MN
Practice Address - Zip Code:56756-9609
Practice Address - Country:US
Practice Address - Phone:218-463-1828
Practice Address - Fax:218-463-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN82361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty