Provider Demographics
NPI:1134345853
Name:FALLIS, JOHN (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FALLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:FALLIS
Other - Last Name:DDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:721 E PECAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-6173
Mailing Address - Country:US
Mailing Address - Phone:972-382-3162
Mailing Address - Fax:972-382-8114
Practice Address - Street 1:721 E PECAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-6173
Practice Address - Country:US
Practice Address - Phone:972-382-3162
Practice Address - Fax:972-382-8114
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice