Provider Demographics
NPI:1033326517
Name:TAYLOR, ALISA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
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 1:1200 NETWORK CENTRE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4637
Mailing Address - Country:US
Mailing Address - Phone:217-540-5800
Mailing Address - Fax:217-342-2557
Practice Address - Street 1:1200 NETWORK CENTRE DR
Practice Address - Street 2:SUITE B
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4637
Practice Address - Country:US
Practice Address - Phone:217-540-5800
Practice Address - Fax:217-342-2557
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist