Provider Demographics
NPI:1770273294
Name:TAYLOR, KATHRYN HAAG (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:HAAG
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 THORNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1679
Mailing Address - Country:US
Mailing Address - Phone:270-825-9616
Mailing Address - Fax:270-825-3901
Practice Address - Street 1:1250 THORNBERRY DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1679
Practice Address - Country:US
Practice Address - Phone:270-825-9616
Practice Address - Fax:270-825-3901
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY10970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program