Healthcare Provider Details

I. General information

NPI: 1518890763
Provider Name (Legal Business Name): TAYLOR LAUREN LAVENDER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N ARIZONA BLVD
COOLIDGE AZ
85128-3215
US

IV. Provider business mailing address

1501 N ARIZONA BLVD
COOLIDGE AZ
85128-3215
US

V. Phone/Fax

Practice location:
  • Phone: 520-723-1700
  • Fax:
Mailing address:
  • Phone: 520-723-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012842
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: