Provider Demographics
NPI:1730475872
Name:TAYLOR, JENNIFER WINCHESTER (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WINCHESTER
Last Name:TAYLOR
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 1:104 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-2012
Mailing Address - Country:US
Mailing Address - Phone:252-823-0551
Mailing Address - Fax:252-823-0552
Practice Address - Street 1:104 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2012
Practice Address - Country:US
Practice Address - Phone:252-823-0551
Practice Address - Fax:252-823-0552
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist