Mark Anthony Tallis, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4456 Issued in LA

Practice address

5225 Odonovan Dr
Suite 103
Baton Rouge, LA 70808-7202

Phone

(225) 769-8555

Fax

(225) 766-8579

NPI assigned

Mar 30, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459296000000",
    "number": "1679936447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5225 ODONOVAN DR",
            "address_2": "SUITE 103",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708087202",
            "telephone_number": "225-769-8555",
            "fax_number": "225-766-8579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 ODONOVAN DR",
            "address_2": "SUITE 103",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708087202",
            "telephone_number": "225-769-8555",
            "fax_number": "225-766-8579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLIS",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-30",
        "last_updated": "2016-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "4456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cari Talley
• Catherine Ford Talley, RN
• Lindsey Talley, NP
• Lydia B Talley, LPC-S, NCC
• Mallory O'Brien Talley
• Hilary Tallman, LCSW
• Asif Talukder, M.D.
• Harpreet Kaur Talwar, M.D.
• Ajay Vinayak Tambe, MD
• Tamiko Mayo MD

• General Practice Dentistry in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.