Individual provider Active NPI

Joseph Henry Fallon IV, D.D.S.

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1184748725
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
25515 Issued in CA
Practice address
4633 Ingraham St
Suite a
San Diego, CA 92109-8713
Phone
(858) 272-3771
Fax
(858) 272-3799
NPI assigned
Mar 19, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 25515 CA Primary

Addresses

Primary practice location

4633 Ingraham St
Suite a
San Diego, CA 92109-8713

Mailing address

4633 Ingraham St
Suite a
San Diego, CA 92109-8713
Phone (858) 272-3771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
25515CAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184748725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4633 INGRAHAM ST",
            "address_2": "SUITE A",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921098713",
            "telephone_number": "858-272-3771",
            "fax_number": "858-272-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4633 INGRAHAM ST",
            "address_2": "SUITE A",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921098713",
            "telephone_number": "858-272-3771",
            "fax_number": "858-272-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLON",
        "first_name": "JOSEPH",
        "middle_name": "HENRY",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "25515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.