Provider Demographics
NPI:1366018103
Name:DUPREY, TAELOR LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAELOR
Middle Name:LYNN
Last Name:DUPREY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14698 BARTRAM CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7061
Mailing Address - Country:US
Mailing Address - Phone:904-315-3347
Mailing Address - Fax:
Practice Address - Street 1:12667 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7172
Practice Address - Country:US
Practice Address - Phone:904-250-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN258611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty