Provider Demographics
NPI:1609004746
Name:TALLEY, ANDREA M (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
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 1:5811 JACK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-5025
Mailing Address - Country:US
Mailing Address - Phone:251-368-9136
Mailing Address - Fax:251-368-2944
Practice Address - Street 1:429 BUFORD L ROLIN DR
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-5190
Practice Address - Country:US
Practice Address - Phone:251-368-9136
Practice Address - Fax:251-368-2944
Is Sole Proprietor?:No
Enumeration Date:2009-06-28
Last Update Date:2024-09-30
Deactivation Date:2024-08-13
Deactivation Code:
Reactivation Date:2024-09-26
Provider Licenses
StateLicense IDTaxonomies
CO000202459122300000X
LA6106122300000X
ALD.007263-C122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist