Provider Demographics
NPI:1477883080
Name:TAYLOR, SOPHIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOPHIE
Middle Name:
Last Name:TAYLOR
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 1:1721 5TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1820
Mailing Address - Country:US
Mailing Address - Phone:415-785-3445
Mailing Address - Fax:415-785-3623
Practice Address - Street 1:1721 5TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1820
Practice Address - Country:US
Practice Address - Phone:415-785-3445
Practice Address - Fax:415-785-3623
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist