Individual
JOSHUA TALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5300 ALLEN RD, ALLEN PARK, MI 48101-2924
(313) 928-6684
Mailing address
5300 ALLEN RD, ALLEN PARK, MI 48101-2924
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901022295
MI
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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