Provider Demographics
NPI:1558005850
Name:TAYLOR, PEYTON BLAIR (RDH)
Entity Type:Individual
Prefix:MRS
First Name:PEYTON
Middle Name:BLAIR
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 VANN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6098
Mailing Address - Country:US
Mailing Address - Phone:731-660-8981
Mailing Address - Fax:
Practice Address - Street 1:1119 VANN DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6098
Practice Address - Country:US
Practice Address - Phone:731-660-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9463124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist