Provider Demographics
NPI:1912668070
Name:TALDG PLLC
Entity Type:Organization
Organization Name:TALDG PLLC
Other - Org Name:FT. GIBSON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GROWTH
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-250-2255
Mailing Address - Street 1:801 S LEE ST STE A
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-8710
Mailing Address - Country:US
Mailing Address - Phone:918-478-4433
Mailing Address - Fax:
Practice Address - Street 1:801 S LEE ST STE A
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434-8710
Practice Address - Country:US
Practice Address - Phone:918-478-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-31
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty