Provider Demographics
NPI:1548610363
Name:TAYLOR, TINA HSU (DMD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:HSU
Last Name:TAYLOR
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 1:20 WHITE TAIL TER
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-9398
Mailing Address - Country:US
Mailing Address - Phone:858-337-3685
Mailing Address - Fax:
Practice Address - Street 1:1001 S MARKET ST
Practice Address - Street 2:SUITE F
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4748
Practice Address - Country:US
Practice Address - Phone:717-766-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0094971223G0001X
PADS041074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice