Provider Demographics
NPI:1215150446
Name:SAM S. FALTAS, DDS LLC
Entity type:Organization
Organization Name:SAM S. FALTAS, DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:FALTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-607-1858
Mailing Address - Street 1:4 WOLF LN
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2200
Mailing Address - Country:US
Mailing Address - Phone:908-607-1858
Mailing Address - Fax:
Practice Address - Street 1:20 N FINLEY AVE
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1143
Practice Address - Country:US
Practice Address - Phone:908-766-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ184111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty