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General NPI Number Information
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NPI Number | 1518342641
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Entity Type | Organization
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Legal Business Name | MATTHEW TALCOTT DDS PC
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 434 N CENTER ST
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City | NORTHVILLE
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State | MI
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Zip | 48167-1224
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Country | US
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Telephone | 248-349-4111
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Fax | 248-349-4849
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Provider Business Mailing Address
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Address Line | 434 N CENTER ST
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City | NORTHVILLE
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State | MI
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Zip | 48167-1224
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Country | US
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Telephone | 248-349-4111
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Fax | 248-349-4849
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW JASON TALCOTT
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Credential | DDS
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Telephone | 248-349-4111
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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 | 17081
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License Number State | MI
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