Michael William Fallon III, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

042589 Issued in NY

Practice address

5109 W Genesee St
Suite 105
Camillus, NY 13031-2352

Phone

(315) 487-9377

Fax

(315) 488-1017

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447632000000",
    "number": "1265520613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5109 W GENESEE ST STE 105",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312372",
            "telephone_number": "315-487-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5109 W GENESEE ST",
            "address_2": "SUITE 105",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312352",
            "telephone_number": "315-487-9377",
            "fax_number": "315-488-1017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLON",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2015-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "042589",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "42076",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Engelbrecht, RN
• Marc Darren Engle, D.D.S.
• Epc, LLC
• Fairmount Family Medicine PLLC
• Anne Marie G Fallon, D.D.S.
• Familycare Medical Group PC
• Donna H Farchione, M.S., CCC-SLP, LMFT
• Gregory Faughnan, MD
• Robert Louis Felter, MD
• Joseph Frederick Finelli Jr., D.D.S.

• General Practice Dentistry in Camillus, NY
• Providers in Camillus, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; 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.

Verify at the official NPI Registry.