Provider Demographics
NPI:1417574179
Name:LUNDQUIST, TAYLOR ALEXANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ALEXANDRA
Last Name:LUNDQUIST
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 1:1017 N HUME AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1771
Mailing Address - Country:US
Mailing Address - Phone:218-205-5011
Mailing Address - Fax:
Practice Address - Street 1:306 W MCMILLAN ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-6013
Practice Address - Country:US
Practice Address - Phone:715-387-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002320-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice