Provider Demographics
NPI:1316687205
Name:TALLEY, ALEXANDRIA DOROTHY (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:DOROTHY
Last Name:TALLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11939 N GRAND PKWY E STE 500
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-1818
Mailing Address - Country:US
Mailing Address - Phone:409-939-4078
Mailing Address - Fax:
Practice Address - Street 1:11939 N GRAND PKWY E STE 500
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-1818
Practice Address - Country:US
Practice Address - Phone:281-612-4138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7662122300000X
GADN123042122300000X
LA73651223G0001X
TX402221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist