Provider Demographics
NPI:1003291162
Name:TAYLOR, HEATHER DANIELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:DANIELLE
Last Name:TAYLOR
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 1:1170 BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4372
Mailing Address - Country:US
Mailing Address - Phone:618-345-1400
Mailing Address - Fax:618-344-1401
Practice Address - Street 1:1170 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4372
Practice Address - Country:US
Practice Address - Phone:618-345-1400
Practice Address - Fax:618-344-1401
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist