Provider Demographics
NPI:1073943916
Name:TAYLOR, REBECCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 KULSHAN VIEW DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2779
Mailing Address - Country:US
Mailing Address - Phone:360-424-0123
Mailing Address - Fax:360-424-9023
Practice Address - Street 1:8405 196TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-6313
Practice Address - Country:US
Practice Address - Phone:360-424-0123
Practice Address - Fax:360-424-9023
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60402643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist