Provider Demographics
NPI:1922661552
Name:FOSTER, TAYLOR ASHLEY
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ASHLEY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3391 KERR RD
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9260
Mailing Address - Country:US
Mailing Address - Phone:740-441-5659
Mailing Address - Fax:
Practice Address - Street 1:530 E BROMLEY LN UNIT 100
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-5502
Practice Address - Country:US
Practice Address - Phone:303-637-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002045371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice