Provider Demographics
NPI:1770800104
Name:TALOSIG, PAUL G (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:TALOSIG
Suffix:
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 1:402 S WINFREE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2942
Mailing Address - Country:US
Mailing Address - Phone:936-258-2624
Mailing Address - Fax:187-763-1248
Practice Address - Street 1:402 S WINFREE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2942
Practice Address - Country:US
Practice Address - Phone:936-258-2624
Practice Address - Fax:187-763-1248
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-25
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist