Provider Demographics
NPI:1679521942
Name:USCOLA, TAFFY ELLEN (RDH)
Entity Type:Individual
Prefix:
First Name:TAFFY
Middle Name:ELLEN
Last Name:USCOLA
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 1:4660 W CHRYSAN CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-9273
Mailing Address - Country:US
Mailing Address - Phone:907-356-6858
Mailing Address - Fax:
Practice Address - Street 1:724 POSTAL SERVICE LOOP
Practice Address - Street 2:#7500
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-5001
Practice Address - Country:US
Practice Address - Phone:907-353-2917
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK973124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist