Provider Demographics
NPI:1689608077
Name:TAYLOR, JEANNE (DR)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WOODVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5495
Mailing Address - Country:US
Mailing Address - Phone:512-327-4386
Mailing Address - Fax:512-306-8821
Practice Address - Street 1:3410 FAR WEST BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3194
Practice Address - Country:US
Practice Address - Phone:512-343-2425
Practice Address - Fax:512-418-1645
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice