Provider Demographics
NPI:1710531017
Name:MCFADDEN, TAYLOR LEIGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:LEIGH
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WALTON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1451
Mailing Address - Country:US
Mailing Address - Phone:270-925-5388
Mailing Address - Fax:
Practice Address - Street 1:265 KY ROUTE 122
Practice Address - Street 2:SUITE 2
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649
Practice Address - Country:US
Practice Address - Phone:606-949-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice