Provider Demographics
NPI:1043497050
Name:TAYLOR, KELLY RYAN (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RYAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 CARLSBAD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1950
Mailing Address - Country:US
Mailing Address - Phone:760-434-7645
Mailing Address - Fax:
Practice Address - Street 1:1291 CARLSBAD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1950
Practice Address - Country:US
Practice Address - Phone:760-434-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics