Provider Demographics
NPI:1134685407
Name:TAYLOR, LINDSEY LEE (RDH)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-5422
Mailing Address - Country:US
Mailing Address - Phone:208-642-9379
Mailing Address - Fax:208-642-5004
Practice Address - Street 1:1501 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-5422
Practice Address - Country:US
Practice Address - Phone:208-642-9379
Practice Address - Fax:208-642-5004
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDH3141124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist