Provider Demographics
NPI:1427544808
Name:TAGG, DYLAN T (DMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:T
Last Name:TAGG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7349 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7221
Mailing Address - Country:US
Mailing Address - Phone:757-564-8942
Mailing Address - Fax:
Practice Address - Street 1:7349 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7221
Practice Address - Country:US
Practice Address - Phone:757-564-8942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23460122300000X
VA0401417406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist