Healthcare Provider Details

I. General information

NPI: 1063870483
Provider Name (Legal Business Name): MARTIN TALIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 MAIN ST STE 101
AGAWAM MA
01001-1803
US

IV. Provider business mailing address

15 HOLLY CIR
EASTHAMPTON MA
01027-2705
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-2341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1859541
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number016.0134389
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number100962
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number14635
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: