Active NPI
Bruce Douglas Falk, DDS
- Dentist
- Salol, MN
National Provider Identifier
1205997442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D8236
- Practice address
- 49949 350TH St
Salol, MN 56756-9609 - Phone
- (218) 463-1828
- Fax
- (218) 463-3013
- NPI assigned
- Dec 12, 2006
- Last updated
- Mar 19, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D8236 | MN | Primary |
Addresses
Primary practice location
49949 350TH St
Salol, MN 56756-9609
Mailing address
49949 350TH St
Salol, MN 56756-9609
Phone (218) 463-1828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150429001125 | MN | Order and Referring Only - Dentist | 3577882398 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8236 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bruce D. Falk | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395187200000",
"number": "1205997442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "49949 350TH ST",
"city": "SALOL",
"state": "MN",
"postal_code": "567569609",
"telephone_number": "218-463-1828",
"fax_number": "218-463-3013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49949 350TH ST",
"city": "SALOL",
"state": "MN",
"postal_code": "567569609",
"telephone_number": "218-463-1828",
"fax_number": "218-463-3013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FALK",
"first_name": "BRUCE",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2014-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D8236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salol, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.