Provider Demographics
NPI:1962533588
Name:FALLS DENTAL GROUP LLC
Entity type:Organization
Organization Name:FALLS DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:N.
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-251-6070
Mailing Address - Street 1:N88W17001 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2828
Mailing Address - Country:US
Mailing Address - Phone:262-251-6070
Mailing Address - Fax:262-250-9000
Practice Address - Street 1:N88W17001 MAIN ST
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2828
Practice Address - Country:US
Practice Address - Phone:262-251-6070
Practice Address - Fax:262-250-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty