Provider Demographics
NPI:1679203160
Name:HATFIELD, TAYLOR NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:NICOLE
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 W OLD ROAD 30
Mailing Address - Street 2:
Mailing Address - City:ETNA GREEN
Mailing Address - State:IN
Mailing Address - Zip Code:46524-9775
Mailing Address - Country:US
Mailing Address - Phone:574-453-6930
Mailing Address - Fax:574-269-3506
Practice Address - Street 1:1603 N DETROIT ST UNIT A
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-2274
Practice Address - Country:US
Practice Address - Phone:574-269-7377
Practice Address - Fax:574-269-3506
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013835A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice