Provider Demographics
NPI:1902344948
Name:FALAFULKING DENTAL PLLC
Entity Type:Organization
Organization Name:FALAFULKING DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:KINGSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-288-8582
Mailing Address - Street 1:4110 FAIRMOUNT ST
Mailing Address - Street 2:2111
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3349
Mailing Address - Country:US
Mailing Address - Phone:954-288-8582
Mailing Address - Fax:
Practice Address - Street 1:4110 FAIRMOUNT ST
Practice Address - Street 2:2111
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3349
Practice Address - Country:US
Practice Address - Phone:954-288-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty