1346526985 NPI number — JULIE DAVID TALAIVER DDS, PLLC

Table of content: DESIREE ANN COLONICA LCSW (NPI 1790069672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346526985 NPI number — JULIE DAVID TALAIVER DDS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIE DAVID TALAIVER DDS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346526985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4755 GRAMERCY OAKS DR
Provider Second Line Business Mailing Address:
APT #421
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75287-5333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-457-0638
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 BEEBALM LN
Provider Second Line Business Practice Location Address:
STE #200
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75040-2955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-457-0638
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TALAIVER
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-457-0638

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  21891 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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