Provider Demographics
NPI:1013020031
Name:TAYLOR, VICTORIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
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 1:88 BROAD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4382
Mailing Address - Country:US
Mailing Address - Phone:518-831-1702
Mailing Address - Fax:
Practice Address - Street 1:88 BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4382
Practice Address - Country:US
Practice Address - Phone:518-831-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11417OtherBCBS PROVIDER NUMBER
MA1390890OtherUNITED CONCORDIA PROV. #