Provider Demographics
NPI:1104455245
Name:ROZHITSKY, FALON (DMD, MS, MBA)
Entity type:Individual
Prefix:DR
First Name:FALON
Middle Name:
Last Name:ROZHITSKY
Suffix:
Gender:F
Credentials:DMD, MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BRYCE CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-5034
Mailing Address - Country:US
Mailing Address - Phone:917-923-0500
Mailing Address - Fax:
Practice Address - Street 1:2029 VALLEYGATE DR STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3772
Practice Address - Country:US
Practice Address - Phone:917-538-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0417561223X0400X
NC120981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS041756Medicaid