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General NPI Number Information
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NPI Number | 1366824500
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Entity Type | Individual
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Provider Name | JOSHUA NELSON TALLEY D.M.D
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Gender | Male
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 1102 MAIN ST
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City | TEXARKANA
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State | TX
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Zip | 75501-4313
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Country | US
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Telephone | 903-792-5924
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Fax | 903-792-8224
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Provider Business Mailing Address
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Address Line | 1102 MAIN ST
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City | TEXARKANA
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State | TX
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Zip | 75501-4313
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Country | US
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Telephone | 903-792-5924
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Fax | 903-792-8224
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31060
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License Number State | TX
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