Provider Demographics
NPI:1225726201
Name:FALCON ANDARA, FERNANDO ALBERTO
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:ALBERTO
Last Name:FALCON ANDARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4785 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2136
Mailing Address - Country:US
Mailing Address - Phone:440-282-6677
Mailing Address - Fax:
Practice Address - Street 1:4785 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2136
Practice Address - Country:US
Practice Address - Phone:440-282-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0281441223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice