Provider Demographics
NPI:1851768741
Name:KENT, TAYLOR MITCHELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:MITCHELL
Last Name:KENT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LEIGH
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2145 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2899
Mailing Address - Country:US
Mailing Address - Phone:510-865-4551
Mailing Address - Fax:
Practice Address - Street 1:2145 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2899
Practice Address - Country:US
Practice Address - Phone:510-865-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist