Provider Demographics
NPI:1013067347
Name:FALCON, VICTOR MANUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:FALCON
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:PO BOX 4167
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00958
Mailing Address - Country:UM
Mailing Address - Phone:787-799-5130
Mailing Address - Fax:787-279-0063
Practice Address - Street 1:BELLA VISTA GARDENS
Practice Address - Street 2:D-10B CALLE 2
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00957
Practice Address - Country:UM
Practice Address - Phone:787-799-5130
Practice Address - Fax:787-279-0063
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR041098OtherCRUZ AZUL
PR9580032OtherHUMANA INSURANCE
PR41189OtherSSS