Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 029786 | NY |
N | 213EG0000X | General Practice | 029786 | NY |
N | 1223P0700X | Prosthodontist | 029786 | NY |
NPI | 1043310972 |
---|---|
Provider Name | Ross Tallents |
First Address | Rochester, NY 14618-2668 |
Second Address | Rochester, NY 14618-2668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |