1134240617 NPI number — ORAL AND MAXILLO-FACIAL SURGERY ASSOC

Table of content: (NPI 1134240617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134240617 NPI number — ORAL AND MAXILLO-FACIAL SURGERY ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORAL AND MAXILLO-FACIAL SURGERY ASSOC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR.THOMAS J FALLON,D.D.S.,P.C.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134240617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 W TAFT RD
Provider Second Line Business Mailing Address:
3M
Provider Business Mailing Address City Name:
LIVERPOOL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13088-3807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-452-2570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 W TAFT RD
Provider Second Line Business Practice Location Address:
3M
Provider Business Practice Location Address City Name:
LIVERPOOL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13088-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-452-2570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FALLON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ORAL SURGEON
Authorized Official Telephone Number:
315-452-2570

Provider Taxonomy Codes

  • Taxonomy code: 1223P0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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