Provider Demographics
NPI:1760274146
Name:TALLBACKA, SADIE ANN (DMD)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:ANN
Last Name:TALLBACKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 SW ARCHER RD APT 3030
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1018
Mailing Address - Country:US
Mailing Address - Phone:772-485-9650
Mailing Address - Fax:
Practice Address - Street 1:6820 MATTHEWS MINT HILL RD STE 204
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9492
Practice Address - Country:US
Practice Address - Phone:704-800-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program