MEDICARE: DR. TAYLOR ELIZABETH HARTLEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	00000000000	PA
2	122300000X	Dentist	DS-042252	PA

General Provider Information

NPI Number	:	1578122461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLOR ELIZABETH HARTLEY DMD

Provider Business Mailing Address
First Line	:	109 GROVE HILL LN
Second Line	:
City	:	ZELIENOPLE
State	:	PA
Zip	:	16063-3038
Country	:	US
Telephone Number	:	724-417-0327
Fax Number	:

Provider Business Practice Location Address
First Line	:	4075 MONROEVILLE BLVD STE 200
Second Line	:
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-2529
Country	:	US
Telephone Number	:	412-856-4877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	03/18/2024

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