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General NPI Number Information
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NPI Number | 1053245852
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Entity Type | Individual
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Provider Name | NOAH BENJAMIN TALLY DDS
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Gender | Male
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Dates
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Enumeration Date | 06/09/2026
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 13650 ROE BLVD
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City | LEAWOOD
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State | KS
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Zip | 66224-3757
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Country | US
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Telephone | 913-491-5040
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 W 176TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66085-8542
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Country | US
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Telephone | 913-617-4867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 62387
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License Number State | KS
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