Provider Demographics
NPI:1639147176
Name:TAYLOR, DOROTHEA GERTRUDE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHEA
Middle Name:GERTRUDE
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 1:505 WASHINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3571
Mailing Address - Country:US
Mailing Address - Phone:803-648-4243
Mailing Address - Fax:803-685-5519
Practice Address - Street 1:634 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGE SPRING
Practice Address - State:SC
Practice Address - Zip Code:29129-9139
Practice Address - Country:US
Practice Address - Phone:803-685-5555
Practice Address - Fax:803-685-5519
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC26021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice