Provider Demographics
NPI:1316162282
Name:FALSAFI, REBECCA (DDS, MS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FALSAFI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 TRANSIT RD STE 10
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2606
Mailing Address - Country:US
Mailing Address - Phone:716-631-2166
Mailing Address - Fax:716-639-7312
Practice Address - Street 1:6161 TRANSIT RD STE 10
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2606
Practice Address - Country:US
Practice Address - Phone:716-631-2166
Practice Address - Fax:716-639-7312
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044065-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01763708Medicaid