Provider Demographics
NPI:1306399688
Name:TAYLOR, BETHANY NOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:NOEL
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 1:1111 S MAIN ST STE 330
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4747
Mailing Address - Country:US
Mailing Address - Phone:419-419-0779
Mailing Address - Fax:
Practice Address - Street 1:1111 S MAIN ST STE 330
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4747
Practice Address - Country:US
Practice Address - Phone:419-419-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.24843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist