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General NPI Number Information
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NPI Number | 1063870483
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Entity Type | Individual
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Provider Name | MARTIN TALIA DDS
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Gender | Male
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 158 MAIN ST STE 101
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City | AGAWAM
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State | MA
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Zip | 01001-1803
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Country | US
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Telephone | 413-786-2341
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Fax |
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Provider Business Mailing Address
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Address Line | 15 HOLLY CIR
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City | EASTHAMPTON
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State | MA
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Zip | 01027-2705
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Country | US
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Telephone |
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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 | DN1859541
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 016.0134389
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 100962
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 14635
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License Number State | CT
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