Provider Demographics
NPI:1205997442
Name:FALK, BRUCE DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DOUGLAS
Last Name:FALK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49949 350TH ST
Mailing Address - Street 2:
Mailing Address - City:SALOL
Mailing Address - State:MN
Mailing Address - Zip Code:56756-9609
Mailing Address - Country:US
Mailing Address - Phone:218-463-1828
Mailing Address - Fax:218-463-3013
Practice Address - Street 1:49949 350TH ST
Practice Address - Street 2:
Practice Address - City:SALOL
Practice Address - State:MN
Practice Address - Zip Code:56756-9609
Practice Address - Country:US
Practice Address - Phone:218-463-1828
Practice Address - Fax:218-463-3013
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist