Provider Demographics
NPI:1689168064
Name:DUCKWORTH, TAYLOR TRACY (DDS)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:TRACY
Last Name:DUCKWORTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1842
Mailing Address - Country:US
Mailing Address - Phone:615-329-4401
Mailing Address - Fax:615-321-6175
Practice Address - Street 1:324 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1842
Practice Address - Country:US
Practice Address - Phone:615-329-4401
Practice Address - Fax:615-321-6175
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist