Provider Demographics
NPI:1376696815
Name:TALCOTT, MATTHEW J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:TALCOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:J
Other - Last Name:TALCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:434 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1224
Mailing Address - Country:US
Mailing Address - Phone:248-349-4111
Mailing Address - Fax:248-349-4849
Practice Address - Street 1:434 N CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1224
Practice Address - Country:US
Practice Address - Phone:248-349-4111
Practice Address - Fax:248-349-4849
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI170811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice