Provider Demographics
NPI:1841906641
Name:JOSHUA P TALLY DDS PLLC
Entity type:Organization
Organization Name:JOSHUA P TALLY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-928-8237
Mailing Address - Street 1:5300 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2924
Mailing Address - Country:US
Mailing Address - Phone:313-928-8237
Mailing Address - Fax:
Practice Address - Street 1:5300 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2924
Practice Address - Country:US
Practice Address - Phone:313-928-8237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental