Provider Demographics
NPI:1255031589
Name:TALL DENTAL, INC.
Entity type:Organization
Organization Name:TALL DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-557-3050
Mailing Address - Street 1:14606 NE RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-7500
Mailing Address - Country:US
Mailing Address - Phone:909-557-3050
Mailing Address - Fax:
Practice Address - Street 1:38761 CHERRY VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92223-4239
Practice Address - Country:US
Practice Address - Phone:951-769-5487
Practice Address - Fax:951-769-5488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TALL DENTAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811133945OtherNPI TYPE 1