Individual
DR. MARK ANTHONY TALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5225 ODONOVAN DR, SUITE 103, BATON ROUGE, LA 70808-7202
(225) 769-8555
(225) 766-8579
Mailing address
5225 ODONOVAN DR, SUITE 103, BATON ROUGE, LA 70808-7202
(225) 769-8555
(225) 766-8579
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4456
LA
Other
Enumeration date
03/30/2016
Last updated
03/30/2016
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