Provider Demographics
NPI:1336476829
Name:TAGGART, CHRISTINE (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:TAGGART
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 1:2901 OVERSEAS HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2235
Mailing Address - Country:US
Mailing Address - Phone:305-289-8915
Mailing Address - Fax:
Practice Address - Street 1:2901 OVERSEAS HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2235
Practice Address - Country:US
Practice Address - Phone:305-289-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHAD101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice