Provider Demographics
NPI:1053100503
Name:FALLON L STIENS DDS FAMILY DENTAL LLC
Entity type:Organization
Organization Name:FALLON L STIENS DDS FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FALLON
Authorized Official - Middle Name:
Authorized Official - Last Name:STIENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:660-783-2205
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:STANBERRY
Mailing Address - State:MO
Mailing Address - Zip Code:64489-0203
Mailing Address - Country:US
Mailing Address - Phone:660-783-2205
Mailing Address - Fax:660-783-9021
Practice Address - Street 1:3524 US HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:STANBERRY
Practice Address - State:MO
Practice Address - Zip Code:64489-8210
Practice Address - Country:US
Practice Address - Phone:660-783-2205
Practice Address - Fax:660-783-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty