Provider Demographics
NPI:1568115186
Name:TALBERT FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:TALBERT FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-679-9928
Mailing Address - Street 1:24919 GROVEHILL LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-8703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1079 BALCH RD STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8817
Practice Address - Country:US
Practice Address - Phone:256-679-9928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental