Provider Demographics
NPI:1720406432
Name:TALIAFERRO, CHELSEA (DMD)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:TALIAFERRO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 E 103RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7081
Mailing Address - Country:US
Mailing Address - Phone:918-970-4944
Mailing Address - Fax:
Practice Address - Street 1:8222 E 103RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7081
Practice Address - Country:US
Practice Address - Phone:918-970-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK68651223G0001X
OK1011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry