Provider Demographics
NPI:1659851814
Name:NIELSEN, TAYLOR TODD HENRY (DMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:TODD HENRY
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20285 SW TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2302
Mailing Address - Country:US
Mailing Address - Phone:503-334-0930
Mailing Address - Fax:
Practice Address - Street 1:20285 SW TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-2302
Practice Address - Country:US
Practice Address - Phone:503-334-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD108861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice