Provider Demographics
NPI:1609928662
Name:TAYLOR, WENDY KRELLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:KRELLER
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:KRELLER
Other - Last Name:BARRIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1503 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-484-4806
Mailing Address - Fax:318-484-4806
Practice Address - Street 1:1503 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-484-4801
Practice Address - Fax:318-484-4806
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1848565Medicaid