Provider Demographics
NPI:1841572716
Name:TAYLOR, KIMBERLY MISAKO (EFDA, EFODA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MISAKO
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:EFDA, EFODA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MCLOUGHLIN BLVD STE 68
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 MCLOUGHLIN BLVD STE 68
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1072
Practice Address - Country:US
Practice Address - Phone:503-387-8000
Practice Address - Fax:503-387-8005
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126800000XOtherPTDA