Provider Demographics
NPI:1255902565
Name:ANDERSON, TAYLOR BURKE (DMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BURKE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 ZILLAH WEST RD
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-9542
Mailing Address - Country:US
Mailing Address - Phone:509-314-6600
Mailing Address - Fax:
Practice Address - Street 1:812 ZILLAH WEST RD
Practice Address - Street 2:
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-9542
Practice Address - Country:US
Practice Address - Phone:509-314-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61181825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist