Provider Demographics
NPI:1568960003
Name:TALBERTH, HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:TALBERTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1514
Mailing Address - Country:US
Mailing Address - Phone:617-448-8614
Mailing Address - Fax:
Practice Address - Street 1:32 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1514
Practice Address - Country:US
Practice Address - Phone:617-448-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice