Provider Demographics
NPI:1043410913
Name:TALLBACKA, ERIK J (DMD,FAGD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:J
Last Name:TALLBACKA
Suffix:
Gender:F
Credentials:DMD,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SE OSCEOLA ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2251
Mailing Address - Country:US
Mailing Address - Phone:772-287-4530
Mailing Address - Fax:772-287-9787
Practice Address - Street 1:309 SE OSCEOLA ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2251
Practice Address - Country:US
Practice Address - Phone:772-287-4530
Practice Address - Fax:772-287-9787
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL141161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice