| NPI | 1205978889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANTHONY TALLIS President Of S Corp Dentist Owner 225-769-8555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 4456) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2013-07-09 |