Provider Demographics
NPI:1962578989
Name:FALLERT, VINCENT ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANDREW
Last Name:FALLERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 TESSON FERRY PROFESSIONAL CENTER
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1728
Mailing Address - Country:US
Mailing Address - Phone:314-842-3333
Mailing Address - Fax:314-842-0820
Practice Address - Street 1:12105 TESSON FERRY PROFESSIONAL CENTER
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1728
Practice Address - Country:US
Practice Address - Phone:314-842-3333
Practice Address - Fax:314-842-0820
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist