Basic Information
Provider Information | |||||||||
NPI: | 1376776229 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FALANGA | ||||||||
FirstName: | KRISTEN | ||||||||
MiddleName: | DIANE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DMD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 46 BRITTANY FARMS RD | ||||||||
Address2: | APT #130 | ||||||||
City: | NEW BRITAIN | ||||||||
State: | CT | ||||||||
PostalCode: | 060531265 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5703503280 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 105 MYRTLE ST | ||||||||
Address2: |   | ||||||||
City: | NEW BRITAIN | ||||||||
State: | CT | ||||||||
PostalCode: | 060511859 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8603560057 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/26/2009 | ||||||||
LastUpdateDate: | 11/09/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DS037872 | PA | N |   | Dental Providers | Dentist |   | 122300000X | 10384 | CT | Y |   | Dental Providers | Dentist |   |
No ID Information.