Provider Demographics
NPI:1871796300
Name:FALKOWSKI, JONATHAN JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JOSEPH
Last Name:FALKOWSKI
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 1:19645 PILOT KNOB RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7239
Mailing Address - Country:US
Mailing Address - Phone:651-463-2300
Mailing Address - Fax:651-463-2118
Practice Address - Street 1:15875 EMPEROR AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7860
Practice Address - Country:US
Practice Address - Phone:651-463-2300
Practice Address - Fax:651-463-2118
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist