Provider Demographics
NPI:1225143324
Name:TALLEY, JAMIE CYNTHIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:CYNTHIA
Last Name:TALLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3207
Mailing Address - Country:US
Mailing Address - Phone:405-216-3434
Mailing Address - Fax:405-216-3460
Practice Address - Street 1:411 N BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3207
Practice Address - Country:US
Practice Address - Phone:405-216-3434
Practice Address - Fax:405-216-3460
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice