Provider Demographics
NPI:1417574179
Name:LUNDQUIST, TAYLOR ALEXANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ALEXANDRA
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-0159
Mailing Address - Country:US
Mailing Address - Phone:715-294-2202
Mailing Address - Fax:715-294-9995
Practice Address - Street 1:108 CHIEFTAIN ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-8110
Practice Address - Country:US
Practice Address - Phone:715-294-2202
Practice Address - Fax:715-294-9995
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002320-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice