Provider Demographics
NPI:1598086811
Name:FLONTA, TALIDA MARCIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TALIDA
Middle Name:MARCIANA
Last Name:FLONTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 OLD PLYMOUTH RD
Mailing Address - Street 2:APT 2F
Mailing Address - City:SAGAMORE BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02562-2425
Mailing Address - Country:US
Mailing Address - Phone:419-575-5389
Mailing Address - Fax:
Practice Address - Street 1:117 OLD PLYMOUTH RD
Practice Address - Street 2:APT 2F
Practice Address - City:SAGAMORE BEACH
Practice Address - State:MA
Practice Address - Zip Code:02562-2425
Practice Address - Country:US
Practice Address - Phone:419-575-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18554411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice