Provider Demographics
NPI:1851516926
Name:TALTAVALL, JOHN ALFRED III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALFRED
Last Name:TALTAVALL
Suffix:III
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 1:255 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660
Mailing Address - Country:US
Mailing Address - Phone:201-440-9190
Mailing Address - Fax:
Practice Address - Street 1:255 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660
Practice Address - Country:US
Practice Address - Phone:201-440-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018340001223G0001X
NJDI183401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice