Provider Demographics
NPI:1396361200
Name:D'AMICO, TAYLOR ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ANN
Last Name:D'AMICO
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 1:24 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3634
Mailing Address - Country:US
Mailing Address - Phone:508-231-6226
Mailing Address - Fax:
Practice Address - Street 1:273 SW CUTOFF
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2130
Practice Address - Country:US
Practice Address - Phone:508-393-2522
Practice Address - Fax:508-393-8352
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist