Provider Demographics
NPI:1083849046
Name:TAYLOR, EMILY JANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JANE
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 1:30 ROSEDALE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2928
Mailing Address - Country:US
Mailing Address - Phone:860-305-4336
Mailing Address - Fax:
Practice Address - Street 1:831 GUNDERSON AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1425
Practice Address - Country:US
Practice Address - Phone:860-305-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist