Healthcare Provider Details

I. General information

NPI: 1174715510
Provider Name (Legal Business Name): JUANITA R TAYLOR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5339 GEORGETOWN RD
INDIANAPOLIS IN
46254-3716
US

IV. Provider business mailing address

5339 GEORGETOWN RD
INDIANAPOLIS IN
46254-3716
US

V. Phone/Fax

Practice location:
  • Phone: 317-902-8010
  • Fax:
Mailing address:
  • Phone: 317-902-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12011023A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420214
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011023A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: