Provider Demographics
NPI:1902963572
Name:FALCO, MARK ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:FALCO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 S INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 2271
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1405
Mailing Address - Country:US
Mailing Address - Phone:407-804-0770
Mailing Address - Fax:407-804-0773
Practice Address - Street 1:1331 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2271
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1405
Practice Address - Country:US
Practice Address - Phone:407-804-0770
Practice Address - Fax:407-804-0773
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN126881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice