Organization
MARK A TALLIS DDS APDC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ANTHONY TALLIS DDS (PRESIDENT OF S CORP DENTIST OWNER)
(225) 769-8555
Entity
Organization
Contact information
Practice address
5225 O DONOVAN DRIVE, SUITE 103, BATON ROUGE, LA 70808-4353
(225) 769-8555
(225) 766-8579
Mailing address
5225 O DONOVAN DRIVE, SUITE 103, BATON ROUGE, LA 70808-4353
(225) 769-8555
(225) 766-8579
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4456
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1844560
—
LA
Enumeration date
02/12/2007
Last updated
07/09/2013
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