Provider Demographics
NPI:1538592597
Name:FALK, JESSICA A (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:FALK
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1233
Mailing Address - Country:US
Mailing Address - Phone:570-346-1822
Mailing Address - Fax:570-383-0268
Practice Address - Street 1:1640 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1334
Practice Address - Country:US
Practice Address - Phone:570-346-1822
Practice Address - Fax:570-383-0268
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics