Provider Demographics
NPI:1972735181
Name:CARLSBAD VILLAGE ORTHODONTICS
Entity Type:Organization
Organization Name:CARLSBAD VILLAGE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:760-434-7645
Mailing Address - Street 1:1291 CARLSBAD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1950
Mailing Address - Country:US
Mailing Address - Phone:760-434-7645
Mailing Address - Fax:
Practice Address - Street 1:1291 CARLSBAD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1950
Practice Address - Country:US
Practice Address - Phone:760-434-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty