Provider Demographics
NPI:1528105319
Name:FALAMACK ZALTASH D.D.S INC.,
Entity type:Organization
Organization Name:FALAMACK ZALTASH D.D.S INC.,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FALAMACK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALTASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-967-6767
Mailing Address - Street 1:410 S GLENDORA AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-6207
Mailing Address - Country:US
Mailing Address - Phone:626-967-6767
Mailing Address - Fax:626-966-2986
Practice Address - Street 1:410 S GLENDORA AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-6207
Practice Address - Country:US
Practice Address - Phone:626-967-6767
Practice Address - Fax:626-966-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB40769OtherDENTI-CAL