Provider Demographics
NPI:1700936705
Name:FALCON, DAVID
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:FALCON
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:RR 4 BOX 26257
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00953
Mailing Address - Country:UM
Mailing Address - Phone:787-799-4114
Mailing Address - Fax:
Practice Address - Street 1:BELLA VISTA GARDENS
Practice Address - Street 2:D-10B CALLE 2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-799-5130
Practice Address - Fax:787-279-0063
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41388OtherSSS
PR041278OtherCRUZ AZUL
PR9580060OtherHUMANA INSURANCE