Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 5678 | AL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 33179 | AL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 33179 | AL |
NPI | 1275794547 |
---|---|
Provider Name | David Scott Falconer |
First Address | Dothan, AL 36303-1942 |
Second Address | Dothan, AL 36303-1942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 12/04/2018 |