Provider Demographics
NPI:1053458901
Name:TALLEY, ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:TALLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 36TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4746
Mailing Address - Country:US
Mailing Address - Phone:405-321-8030
Mailing Address - Fax:405-321-2108
Practice Address - Street 1:448 36TH AVE NW
Practice Address - Street 2:SUITE 103
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4746
Practice Address - Country:US
Practice Address - Phone:405-321-8030
Practice Address - Fax:405-321-2108
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU12320Medicare UPIN