1538516083 NPI number — MRS. KATIUSKA MCINTOSH FALCON DMD

Table of content: MRS. KATIUSKA MCINTOSH FALCON DMD (NPI 1538516083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538516083 NPI number — MRS. KATIUSKA MCINTOSH FALCON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINTOSH FALCON
Provider First Name:
KATIUSKA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MC INTOSH FALCON
Provider Other First Name:
KATIUSKA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1538516083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 279517
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33027-9517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-808-9526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10051 PINES BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-6186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-808-9526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN 22233 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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