Provider Demographics
NPI:1568039899
Name:TALLENT, JOHN DOCK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOCK
Last Name:TALLENT
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 1:1435 N ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7267
Mailing Address - Country:US
Mailing Address - Phone:704-735-7001
Mailing Address - Fax:
Practice Address - Street 1:1435 N ASPEN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-7267
Practice Address - Country:US
Practice Address - Phone:704-735-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist