Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 054497-1 | NY |
N | 122300000X | Dentist | 3928 | WV |
Y | 122300000X | Dentist | WV3928 | WV |
NPI | 1003047309 |
---|---|
Provider Name | Dr. Melissa Marie Fallon |
First Address | Stonewood, WV 26301 |
Second Address | Fairmont, WV 26554-2748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 23/10/2012 |