Provider Demographics
NPI:1558483040
Name:JAMIE C. TALLEY, PC
Entity Type:Organization
Organization Name:JAMIE C. TALLEY, PC
Other - Org Name:JAMIE C. TALLEY, DDS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:CYNTHIA
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-216-3434
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty