Provider Demographics
NPI:1184748725
Name:FALLON, JOSEPH HENRY IV (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HENRY
Last Name:FALLON
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4633 INGRAHAM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-8713
Mailing Address - Country:US
Mailing Address - Phone:858-272-3771
Mailing Address - Fax:858-272-3799
Practice Address - Street 1:4633 INGRAHAM ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-8713
Practice Address - Country:US
Practice Address - Phone:858-272-3771
Practice Address - Fax:858-272-3799
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA255151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice