Provider Demographics
NPI:1326023540
Name:TAYLOR-FIELDS, KIM LOUISE (RDH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:LOUISE
Last Name:TAYLOR-FIELDS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:LOUISE
Other - Last Name:BEAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7435 VANDERBILT LN NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9444
Mailing Address - Country:US
Mailing Address - Phone:360-731-6964
Mailing Address - Fax:
Practice Address - Street 1:1141 BEACH DR E
Practice Address - Street 2:
Practice Address - City:RETSIL
Practice Address - State:WA
Practice Address - Zip Code:98378
Practice Address - Country:US
Practice Address - Phone:360-895-4700
Practice Address - Fax:360-895-4453
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006611124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5902010Medicaid