Provider Demographics
NPI:1982804126
Name:TALLEY, NATHANIEL W (DDS)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:W
Last Name:TALLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N GARRETT ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644
Mailing Address - Country:US
Mailing Address - Phone:580-225-1020
Mailing Address - Fax:
Practice Address - Street 1:300 N GARRETT
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644
Practice Address - Country:US
Practice Address - Phone:580-225-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist