Provider Demographics
NPI:1518342641
Name:MATTHEW TALCOTT DDS PC
Entity Type:Organization
Organization Name:MATTHEW TALCOTT DDS PC
Other - Org Name:NORTHVILLE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:TALCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-349-4111
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty