Provider Demographics
NPI:1396926275
Name:TALLA, ANJALI (DDS)
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:TALLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANJALI
Other - Middle Name:
Other - Last Name:RAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23204 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7902
Mailing Address - Country:US
Mailing Address - Phone:215-752-2299
Mailing Address - Fax:719-632-7197
Practice Address - Street 1:23204 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-752-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0375351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice