Provider Demographics
NPI:1437435070
Name:TALBOTT, MICHAEL K (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:TALBOTT
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 1:13578 E 131ST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-6400
Mailing Address - Country:US
Mailing Address - Phone:317-773-5833
Mailing Address - Fax:317-773-5991
Practice Address - Street 1:13578 EAST 131 STREET
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6400
Practice Address - Country:US
Practice Address - Phone:317-773-5833
Practice Address - Fax:317-773-5991
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011652A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist