Provider Demographics
NPI:1588864383
Name:TALBOTT, MICHAEL CURTIS (LDN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CURTIS
Last Name:TALBOTT
Suffix:
Gender:M
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E D ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2300
Mailing Address - Country:US
Mailing Address - Phone:509-248-0992
Mailing Address - Fax:509-575-8577
Practice Address - Street 1:303 E D ST
Practice Address - Street 2:SUITE 3
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2300
Practice Address - Country:US
Practice Address - Phone:509-248-0992
Practice Address - Fax:509-575-8577
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN370122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5053228OtherDSHS