Provider Demographics
NPI:1083922504
Name:TAYLOR, TERRA D (RDH)
Entity Type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:TERRA
Other - Middle Name:D
Other - Last Name:TINSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:600 ORONDO AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2800
Mailing Address - Country:US
Mailing Address - Phone:509-662-3860
Mailing Address - Fax:509-664-4585
Practice Address - Street 1:317 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-2920
Practice Address - Country:US
Practice Address - Phone:509-682-6000
Practice Address - Fax:509-682-6296
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60183027124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist