Provider Demographics
NPI:1952186686
Name:FLORENCE, TAYLOR JO (DMD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:JO
Last Name:FLORENCE
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 1:10145 CALLE MARIA ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89508-8515
Mailing Address - Country:US
Mailing Address - Phone:775-842-5440
Mailing Address - Fax:
Practice Address - Street 1:242 LOS ALTOS PKWY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7708
Practice Address - Country:US
Practice Address - Phone:775-354-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV79111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice