Provider Demographics
NPI:1154511004
Name:RICHARD D. TALLON, DDS, PC
Entity Type:Organization
Organization Name:RICHARD D. TALLON, DDS, PC
Other - Org Name:BRANSON DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:TALLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-336-8478
Mailing Address - Street 1:515 BEE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7734
Mailing Address - Country:US
Mailing Address - Phone:417-336-8478
Mailing Address - Fax:417-336-2246
Practice Address - Street 1:515 BEE CREEK RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7734
Practice Address - Country:US
Practice Address - Phone:417-336-8478
Practice Address - Fax:417-336-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty