1104089416 NPI number — DR. TALIA VICTORIA WOOD LAFOND D.M.D.

Table of content: DR. TALIA VICTORIA WOOD LAFOND D.M.D. (NPI 1104089416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104089416 NPI number — DR. TALIA VICTORIA WOOD LAFOND D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAFOND
Provider First Name:
TALIA
Provider Middle Name:
VICTORIA WOOD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOOD
Provider Other First Name:
TALIA
Provider Other Middle Name:
VICTORIA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104089416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 SULLIVAN TRL STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18040-8397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-760-2347
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 SULLIVAN TRL STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18040-8397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-760-2347
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  1858 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DS039081 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)