| Mark A Tallis Dds Apdc | |
|
5225 O Donovan Drive Suite 103 Baton Rouge LA 70808-4353 | |
| (225) 769-8555 | |
| (225) 766-8579 |
| Full Name | Mark A Tallis Dds Apdc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5225 O Donovan Drive, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Mark Anthony Tallis (PRESIDENT OF S CORP DENTIST OWNER) |
| Authorized Official Contact | 2257698555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark A Tallis Dds Apdc 5225 O Donovan Drive Suite 103 Baton Rouge LA 70808-4353 Ph: (225) 769-8555 | Mark A Tallis Dds Apdc 5225 O Donovan Drive Suite 103 Baton Rouge LA 70808-4353 Ph: (225) 769-8555 |
| NPI Number | 1205978889 |
|---|---|
| Provider Enumeration Date | 02/12/2007 |
| Last Update Date | 07/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205978889 | NPI | - | NPPES |
| 1844560 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4456 (Louisiana) | Primary |
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